Provider Demographics
NPI:1366501496
Name:PROMPTCARE HOME INFUSION LLC
Entity Type:Organization
Organization Name:PROMPTCARE HOME INFUSION LLC
Other - Org Name:PROMPT CARE HOME INFUSION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:JARDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-692-2704
Mailing Address - Street 1:51 BETHPAGE RD STE 200B
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4224
Mailing Address - Country:US
Mailing Address - Phone:631-454-4560
Mailing Address - Fax:631-454-4553
Practice Address - Street 1:51 E BETHPAGE RD STE 200B
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4224
Practice Address - Country:US
Practice Address - Phone:631-454-4560
Practice Address - Fax:631-454-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 3336C0003X, 3336C0004X, 3336M0002X, 3336S0011X
NY0280693336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2885578Medicaid
2068698OtherPK
2068698OtherPK