Provider Demographics
NPI:1073656930
Name:TOTAL FAMILY CARE OF 5 TOWNS & ROCKAWAY
Entity Type:Organization
Organization Name:TOTAL FAMILY CARE OF 5 TOWNS & ROCKAWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HYLTON
Authorized Official - Middle Name:I
Authorized Official - Last Name:LIGHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD DCH FAAP
Authorized Official - Phone:718-868-4808
Mailing Address - Street 1:601 JARVIS AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-868-4808
Mailing Address - Fax:718-868-2270
Practice Address - Street 1:601 JARVIS AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-868-4808
Practice Address - Fax:718-868-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty