Provider Demographics
NPI:1760816698
Name:LIVING-AT-HOME MEDICAL, PC
Entity Type:Organization
Organization Name:LIVING-AT-HOME MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:BUN-CHING
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-256-4213
Mailing Address - Street 1:7105 3RD AVE
Mailing Address - Street 2:STE 523
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1308
Mailing Address - Country:US
Mailing Address - Phone:347-256-4213
Mailing Address - Fax:347-517-4523
Practice Address - Street 1:6818 MADELINE CT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5807
Practice Address - Country:US
Practice Address - Phone:347-256-4213
Practice Address - Fax:347-517-4523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205873207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02611392Medicaid