MEDICARE: WHITE GLOVE AGENCY

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	251J00000X	Nursing Care Agency	564642	NY

General Provider Information

NPI Number	:	1346511193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE GLOVE AGENCY

Provider Business Mailing Address
First Line	:	1066 E 38TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1066 E 38TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4416
Country	:	US
Telephone Number	:	631-645-7039
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	VALENCIA SMITH
Credential	:
Telephone Number	:	631-645-7039

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	01/24/2012

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