MEDICARE: AGAPE LUXURY CORP.

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	344600000X	Taxi	B02550	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B02550	OTHER	NY	TLC LICENSE #

General Provider Information

NPI Number	:	1629326616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE LUXURY CORP.

Provider Business Mailing Address
First Line	:	556 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-3715
Country	:	US
Telephone Number	:	718-858-2222
Fax Number	:	646-395-1588

Provider Business Practice Location Address
First Line	:	556 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-3715
Country	:	US
Telephone Number	:	718-858-2222
Fax Number	:	646-395-1588

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARIO N. SENA
Credential	:
Telephone Number	:	917-309-0202

Provider Enumeration Date	:	08/22/2012
Last Update Date	:	08/22/2012

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Directions to “AGAPE LUXURY CORP. ” Practice Location

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