Provider Demographics
NPI:1205174497
Name:TOWN TOTAL HEALTH, LLC
Entity type:Organization
Organization Name:TOWN TOTAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VALENTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-386-1204
Mailing Address - Street 1:2929 WALKER AVE. NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-6402
Mailing Address - Country:US
Mailing Address - Phone:616-791-2829
Mailing Address - Fax:616-735-8532
Practice Address - Street 1:415 CROSSWAYS PARK DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797
Practice Address - Country:US
Practice Address - Phone:516-249-7400
Practice Address - Fax:516-249-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0318523336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140160OtherPK
NY2314881Medicaid
NY03563164Medicaid
6759740004Medicare NSC