MEDICARE: LIFE CARE TESTING. 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	252Y00000X	Early Intervention Provider Agency
2	332BC3200X	Customized Equipment (DME)

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	:	1437781952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CARE TESTING. INC.

Provider Business Mailing Address
First Line	:	910 81ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2851
Country	:	US
Telephone Number	:	718-564-3435
Fax Number	:

Provider Business Practice Location Address
First Line	:	1887 SHORE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6620
Country	:	US
Telephone Number	:	917-292-5573
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HATEM AHMED
Credential	:
Telephone Number	:	718-564-3435

Provider Enumeration Date	:	02/12/2020
Last Update Date	:	02/12/2020

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