Provider Demographics
NPI:1871200139
Name:200FLY INC.
Entity type:Organization
Organization Name:200FLY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPIRITU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-400-5125
Mailing Address - Street 1:4255 ROUTE 9 N STE 5C
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8305
Mailing Address - Country:US
Mailing Address - Phone:732-400-5434
Mailing Address - Fax:732-702-2462
Practice Address - Street 1:4255 ROUTE 9 N STE 5C
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8305
Practice Address - Country:US
Practice Address - Phone:732-400-5434
Practice Address - Fax:732-702-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care