Med At Home LLC
Nurse Practitioner, Gerontology in Allenhurst, NJ. Organization (NPI-2).
NPI number1023946019
StatusActive
Last updated in NPPESJun 1, 2026
Details
- NPI
- 1023946019
- Entity type
- Organization (NPI-2)
- Legal business name
- Med At Home LLC
- Organization subpart
- No
- Enumeration date
- May 11, 2026
- Certification date
- Jun 1, 2026
- Last updated
- Jun 1, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LG0600X | Nurse Practitioner, Gerontology | – | – | Yes |
Practice location
613 Myrtle AveAllenhurst, NJ 07711-1360
Phone 718-208-6747
Mailing address
613 Myrtle AveAllenhurst, NJ 07711-1360
Phone 718-208-6747
Authorized official
Shirley Mamiye
NP
7182086747
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