Provider Demographics
NPI:1053844134
Name:PROCARE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:PROCARE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:SINHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-720-2288
Mailing Address - Street 1:1492 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3910
Mailing Address - Country:US
Mailing Address - Phone:718-720-2288
Mailing Address - Fax:718-720-5444
Practice Address - Street 1:1492 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3910
Practice Address - Country:US
Practice Address - Phone:718-720-2288
Practice Address - Fax:718-720-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034867-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty