Basic Information
| Provider Information | |||||||||
| NPI: | 1477121549 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NY LONG-TERM CARE PHYSICIAN SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 639676 | ||||||||
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| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452639676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592914800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 755 HEMPSTEAD TPKE | ||||||||
| Address2: | |||||||||
| City: | UNIONDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115531111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165651900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2021 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | FORD | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 4846432629 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.