Provider Demographics
NPI:1821543620
Name:EXCELLENCE AND LONGEVITY CENTER
Entity Type:Organization
Organization Name:EXCELLENCE AND LONGEVITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EN
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-865-7766
Mailing Address - Street 1:14627 BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2172
Mailing Address - Country:US
Mailing Address - Phone:718-709-8260
Mailing Address - Fax:646-682-0306
Practice Address - Street 1:14627 BEECH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2172
Practice Address - Country:US
Practice Address - Phone:718-709-8260
Practice Address - Fax:646-682-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care