Provider Demographics
NPI:1255719514
Name:MARKS HOMECARE CDPAP, LLC
Entity type:Organization
Organization Name:MARKS HOMECARE CDPAP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-400-0124
Mailing Address - Street 1:1122 CONEY ISLAND AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2365
Mailing Address - Country:US
Mailing Address - Phone:718-400-0124
Mailing Address - Fax:
Practice Address - Street 1:1122 CONEY ISLAND AVE STE 220
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2365
Practice Address - Country:US
Practice Address - Phone:718-400-0124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1393L001251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health