MEDICARE: RETRO MEDICINE LLC

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	188871	NY

General Provider Information

NPI Number	:	1134385743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETRO MEDICINE LLC

Provider Business Mailing Address
First Line	:	223 WALL ST # 143
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2060
Country	:	US
Telephone Number	:	631-704-9256
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 WALL ST # 143
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2060
Country	:	US
Telephone Number	:	631-704-9256
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	AIDA BECKER
Credential	:	M.D.
Telephone Number	:	631-704-9256

Provider Enumeration Date	:	08/03/2008
Last Update Date	:	07/10/2013

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Directions to “RETRO MEDICINE LLC ” Practice Location

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