MEDICARE: ASOA LLC DBA PHULLON CARE PROVIDERS

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	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1609317460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASOA LLC DBA PHULLON CARE PROVIDERS

Provider Business Mailing Address
First Line	:	2182 PITKIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-3613
Country	:	US
Telephone Number	:	718-215-4011
Fax Number	:	718-215-4042

Provider Business Practice Location Address
First Line	:	2182 PITKIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-3613
Country	:	US
Telephone Number	:	718-215-4011
Fax Number	:	718-215-4042

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOY LANGFORD
Credential	:
Telephone Number	:	718-571-9177

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	05/17/2024

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