1073889010 NPI number — LIFE QUALITY P.T P.C

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 1073889010 NPI number — LIFE QUALITY P.T P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE QUALITY P.T P.C
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:
1073889010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20408 ROCKAWAY POINT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREEZY POINT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11697-1116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-634-7878
Provider Business Mailing Address Fax Number:
718-634-7879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20408 ROCKAWAY POINT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREEZY POINT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11697-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-634-7878
Provider Business Practice Location Address Fax Number:
718-634-7879
Provider Enumeration Date:
03/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MAHMOUD
Authorized Official First Name:
AHMED
Authorized Official Middle Name:
FEKRY
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
917-573-4309

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  018417 , 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)

  • Identifier: 6696905 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02638580 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: MA8417 . This is a "ATLANTIS/EASY CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1000065520 . This is a "AFFINITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10210162 . This is a "AMERIGROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 092282 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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