1255519971 NPI number — LONG ISLAND HOME VISITING PHYSICIAN, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255519971 NPI number — LONG ISLAND HOME VISITING PHYSICIAN, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONG ISLAND HOME VISITING PHYSICIAN, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255519971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 JEAN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYOSSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11791-5914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-888-1202
Provider Business Mailing Address Fax Number:
516-558-7900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3907 PRINCE ST
Provider Second Line Business Practice Location Address:
3G
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354-5399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-888-1202
Provider Business Practice Location Address Fax Number:
516-558-7900
Provider Enumeration Date:
02/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
YUCHUN
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
917-825-9391

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  237534 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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