Provider Demographics
NPI:1801251962
Name:HOME INFUSION GROUP INC.
Entity type:Organization
Organization Name:HOME INFUSION GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KISELEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-676-9070
Mailing Address - Street 1:3052 BRIGHTON 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8088
Mailing Address - Country:US
Mailing Address - Phone:718-676-9070
Mailing Address - Fax:718-676-9111
Practice Address - Street 1:3052 BRIGHTON 1ST ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8088
Practice Address - Country:US
Practice Address - Phone:718-676-9070
Practice Address - Fax:718-676-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY755423001Medicare PIN