| Glory Favor Inc | |
|
1461 E 103rd St Brooklyn NY 11236-4513 | |
| (718) 838-8362 | |
| Not Available |
| Full Name | Glory Favor Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1461 E 103rd St, Brooklyn, New York |
| Authorized Official Name and Position | Philomene Goueliani (OWNER) |
| Authorized Official Contact | 7188388362 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glory Favor Inc 1805 Pitkin Ave Brooklyn NY 11212-7831 Ph: (718) 750-3406 | Glory Favor Inc 1461 E 103rd St Brooklyn NY 11236-4513 Ph: (718) 838-8362 |
| NPI Number | 1093328890 |
|---|---|
| Provider Enumeration Date | 08/31/2020 |
| Last Update Date | 10/29/2025 |
| Certification Date | 10/29/2025 |
| Medicare PECOS PAC ID | 6709276199 |
|---|---|
| Medicare Enrollment ID | O20211129000398 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093328890 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Philomene Goueliani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891102885 PECOS PAC ID: 4385989243 Enrollment ID: I20181220002033 |
| Provider Name | Landry Deuboue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013337252 PECOS PAC ID: 1759503162 Enrollment ID: I20260615002960 |
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