MEDICARE: UBODR

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	009256-1	NY

General Provider Information

NPI Number	:	1184926594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UBODR

Provider Business Mailing Address
First Line	:	6136 64TH ST
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-1023
Country	:	US
Telephone Number	:	646-552-8325
Fax Number	:

Provider Business Practice Location Address
First Line	:	6136 64TH ST
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-1023
Country	:	US
Telephone Number	:	646-552-8325
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GLORILYN M CORPUZ
Credential	:	OTR
Telephone Number	:	646-552-8325

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	11/18/2010

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