1265761191 NPI number — MZL HOME CARE AGENCY LLC

Table of content: (NPI 1265761191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265761191 NPI number — MZL HOME CARE AGENCY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MZL HOME CARE AGENCY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265761191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1819 EAST 13TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11229-2870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-575-9090
Provider Business Mailing Address Fax Number:
718-575-9099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-699-2160
Provider Business Practice Location Address Fax Number:
631-699-2151
Provider Enumeration Date:
12/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HOFMAN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATOR
Authorized Official Telephone Number:
718-575-9090

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1729L001 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1729L001 . This is a "NEW YORK STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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