Provider Demographics
NPI:1649845397
Name:L & G ENTERPRISES USA LLC
Entity type:Organization
Organization Name:L & G ENTERPRISES USA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSHUVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-752-0564
Mailing Address - Street 1:7741 170TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1345
Mailing Address - Country:US
Mailing Address - Phone:646-752-0564
Mailing Address - Fax:
Practice Address - Street 1:11616 QUEENS BLVD STE 240
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7061
Practice Address - Country:US
Practice Address - Phone:917-749-0086
Practice Address - Fax:929-205-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06442319Medicaid