1386196921 NPI number — MEDPRO HOMECARE AGENCY, INC

Table of content: (NPI 1386196921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386196921 NPI number — MEDPRO HOMECARE AGENCY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDPRO HOMECARE AGENCY, INC
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:
1386196921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 W 33RD STREET,
Provider Second Line Business Mailing Address:
6FL, SUITE 2006A
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-816-2201
Provider Business Mailing Address Fax Number:
866-863-5865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 W 33RD STREET
Provider Second Line Business Practice Location Address:
6FL, SUITE 2006A
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-816-2201
Provider Business Practice Location Address Fax Number:
866-863-5865
Provider Enumeration Date:
10/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GUO
Authorized Official First Name:
HANG
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
347-768-2997

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1909L001 , 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: 04474228 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com