Provider Demographics
NPI:1679882484
Name:LONG BEACH FCC PHYSICIAN PRACTICE
Entity Type:Organization
Organization Name:LONG BEACH FCC PHYSICIAN PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LLERANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-897-1065
Mailing Address - Street 1:455 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2301
Mailing Address - Country:US
Mailing Address - Phone:516-897-1065
Mailing Address - Fax:516-897-8347
Practice Address - Street 1:455 E BAY DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2301
Practice Address - Country:US
Practice Address - Phone:516-897-1065
Practice Address - Fax:516-897-8347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital