Provider Demographics
NPI:1659774107
Name:PROHEALTH CARE ASSOCIATES, LLP
Entity Type:Organization
Organization Name:PROHEALTH CARE ASSOCIATES, LLP
Other - Org Name:DELLACORTE FOOTCARE - A DIVISION OF PROHEALTH CARE ASSOCIATES, LLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-622-6000
Mailing Address - Street 1:2800 MARCUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-622-6000
Mailing Address - Fax:516-608-2889
Practice Address - Street 1:59-01 69TH STREET
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378
Practice Address - Country:US
Practice Address - Phone:718-639-3338
Practice Address - Fax:718-639-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003307332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4930830001OtherDME
NYW2L251OtherMEDICARE PTAN