MEDICARE: CITICARE 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	261QC1500X	Community Health Clinic/Center	7002299R	NY

General Provider Information

NPI Number	:	1790803328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITICARE INC

Provider Business Mailing Address
First Line	:	159 W 127TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-3723
Country	:	US
Telephone Number	:	212-749-3507
Fax Number	:	212-666-1679

Provider Business Practice Location Address
First Line	:	159 W 127TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-3723
Country	:	US
Telephone Number	:	212-749-3507
Fax Number	:	212-666-1679

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SILVA FRANKLIN UMUKORO
Credential	:	MBA
Telephone Number	:	212-749-3508

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	12/03/2008

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Directions to “CITICARE INC ” Practice Location

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