Provider Demographics
NPI:1356053508
Name:BEACH PHYSICAL MEDICINE PC
Entity type:Organization
Organization Name:BEACH PHYSICAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-594-6644
Mailing Address - Street 1:5512 E BRITTON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3149
Mailing Address - Country:US
Mailing Address - Phone:562-594-6644
Mailing Address - Fax:
Practice Address - Street 1:5512 E BRITTON DR STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3149
Practice Address - Country:US
Practice Address - Phone:562-594-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty