Provider Demographics
NPI:1477121549
Name:NY LONG-TERM CARE PHYSICIAN SERVICES, PC
Entity Type:Organization
Organization Name:NY LONG-TERM CARE PHYSICIAN SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-643-2629
Mailing Address - Street 1:PO BOX 639676
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9676
Mailing Address - Country:US
Mailing Address - Phone:859-291-4800
Mailing Address - Fax:
Practice Address - Street 1:755 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-1111
Practice Address - Country:US
Practice Address - Phone:516-565-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty