MEDICARE: OPEN DOOR NY HOME CARE SERVICES, 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	2652L001	NY

General Provider Information

NPI Number	:	1922482488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN DOOR NY HOME CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	2816 41ST AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2816 41ST AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3706
Country	:	US
Telephone Number	:	917-589-0283
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BORIS CHERKALIN
Credential	:
Telephone Number	:	917-589-0283

Provider Enumeration Date	:	07/15/2015
Last Update Date	:	02/17/2017

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