Provider Demographics
NPI:1427568716
Name:LONGEVITY HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:LONGEVITY HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NI XIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-618-4428
Mailing Address - Street 1:13107 40TH RD STE E5
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14229 37TH AVE STE M1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4190
Practice Address - Country:US
Practice Address - Phone:718-618-4428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04174892Medicaid