Provider Demographics
NPI:1891858841
Name:HEALTHY LIVING MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:HEALTHY LIVING MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:IRSHAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-300-7130
Mailing Address - Street 1:611 BANNER AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6739
Mailing Address - Country:US
Mailing Address - Phone:718-300-7130
Mailing Address - Fax:
Practice Address - Street 1:2742 BRIGHTON 8TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5205
Practice Address - Country:US
Practice Address - Phone:718-300-7130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty