6677 Broadway LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

6677 BROADWAY LLC

Practice address

140 Beach 119TH St
Rockaway Park, NY 11694-1953

Phone

(718) 938-7183

NPI assigned

Oct 14, 2020

Last updated

Oct 14, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Angela Borukhova

Title

Office Manager

Phone

(718) 938-7183

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602633600000",
    "number": "1063010767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4718 18TH AVE STE 26",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112041260",
            "telephone_number": "718-938-7183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 BEACH 119TH ST",
            "city": "ROCKAWAY PARK",
            "state": "NY",
            "postal_code": "116941953",
            "telephone_number": "718-938-7183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "6677 BROADWAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-14",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "BORUKHOVA",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "718-938-7183"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.