MEDICARE: CITY-WIDE NUESES REGISTRY,INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	9196L001	NY
2	251J00000X	Nursing Care Agency	9196L001	NY
3	251F00000X	Home Infusion Agency	9196L001	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114198587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY-WIDE NUESES REGISTRY,INC

Provider Business Mailing Address
First Line	:	3910 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3018
Country	:	US
Telephone Number	:	718-231-3800
Fax Number	:	718-881-3911

Provider Business Practice Location Address
First Line	:	3910 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3018
Country	:	US
Telephone Number	:	718-231-3800
Fax Number	:	718-881-3911

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL R ANDERSON
Credential	:
Telephone Number	:	718-231-3800

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	03/13/2008

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