Provider Demographics
NPI:1538556600
Name:HOME HEALTH MEDICAL GROUP, P.C.
Entity type:Organization
Organization Name:HOME HEALTH MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-569-3290
Mailing Address - Street 1:201 W 72ND ST
Mailing Address - Street 2:APT 16B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2712
Mailing Address - Country:US
Mailing Address - Phone:201-569-3290
Mailing Address - Fax:
Practice Address - Street 1:201 W 72ND ST
Practice Address - Street 2:APT 16B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2712
Practice Address - Country:US
Practice Address - Phone:201-569-3290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty