MEDICARE: OXYGEN CLINIC LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	247200000X	Other Technician
2	261QM1300X	Multi-Specialty Clinic/Center
3	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1538922273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OXYGEN CLINIC LLC

Provider Business Mailing Address
First Line	:	1659 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3317
Country	:	US
Telephone Number	:	718-290-6298
Fax Number	:

Provider Business Practice Location Address
First Line	:	1659 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3317
Country	:	US
Telephone Number	:	718-255-9955
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	VIKTORIYA GILYADOVA
Credential	:
Telephone Number	:	718-290-6298

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	03/06/2024

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Directions to “OXYGEN CLINIC LLC ” Practice Location

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