Provider Demographics
NPI:1629094529
Name:LONG BEACH COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:LONG BEACH COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-572-6711
Mailing Address - Street 1:615 RIVERSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2121
Mailing Address - Country:US
Mailing Address - Phone:516-571-7795
Mailing Address - Fax:
Practice Address - Street 1:615 RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2121
Practice Address - Country:US
Practice Address - Phone:516-571-7795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NASSAU HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-14
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2908201R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW85341Medicare PIN