# MED AT HOME LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023946019
- **Authorized official:** SHIRLEY MAMIYE NP (NP)
- **Authorized official phone:** (718) 208-6747

## Contact information

- **Practice address:** 613 MYRTLE AVE, ALLENHURST, NJ 07711-1360
- **Practice address phone:** (718) 208-6747
- **Mailing address:** 613 MYRTLE AVE, ALLENHURST, NJ 07711-1360
- **Mailing address phone:** (718) 208-6747

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | — | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/11/2026
- **Last updated:** 06/01/2026