MEDICARE: HOME INFUSION GROUP 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	251F00000X	Home Infusion Agency

General Provider Information

NPI Number	:	1801251962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME INFUSION GROUP INC.

Provider Business Mailing Address
First Line	:	3052 BRIGHTON 1ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8088
Country	:	US
Telephone Number	:	718-676-9070
Fax Number	:	718-676-9111

Provider Business Practice Location Address
First Line	:	3052 BRIGHTON 1ST ST
Second Line	:	SUITE 301
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8088
Country	:	US
Telephone Number	:	718-676-9070
Fax Number	:	718-676-9111

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEXANDER KISELEV
Credential	:
Telephone Number	:	718-676-9070

Provider Enumeration Date	:	12/16/2015
Last Update Date	:	12/01/2016

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