MEDICARE: BRUVILDO-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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1841745585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUVILDO-INC.

Provider Business Mailing Address
First Line	:	65 W MERRICK RD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-5709
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 W MERRICK RD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-5709
Country	:	US
Telephone Number	:	516-812-5120
Fax Number	:

Authorized Official
Title or Position	:	OWNERR
Name	:	BRUNY VILDORIN
Credential	:
Telephone Number	:	917-650-1605

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	08/23/2016

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Directions to “BRUVILDO-INC. ” Practice Location

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