MEDICARE: ELJIN AGUILA RN, CIC

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	163WI0600X	Infection Control Registered Nurse	676030	NY

General Provider Information

NPI Number	:	1780357236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELJIN AGUILA RN, CIC

Provider Business Mailing Address
First Line	:	25217 60TH AVE
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-2423
Country	:	US
Telephone Number	:	347-592-6517
Fax Number	:

Provider Business Practice Location Address
First Line	:	25217 60TH AVE
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-2423
Country	:	US
Telephone Number	:	347-592-6517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2021
Last Update Date	:	07/30/2021

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