Provider Demographics
NPI:1770908162
Name:TRIUMPH MEDICAL CARE P.L.L.C.
Entity type:Organization
Organization Name:TRIUMPH MEDICAL CARE P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:OMANAMHE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASAGBOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-255-3773
Mailing Address - Street 1:165 N VILLAGE AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3761
Mailing Address - Country:US
Mailing Address - Phone:516-255-3773
Mailing Address - Fax:516-255-3778
Practice Address - Street 1:165 N VILLAGE AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3761
Practice Address - Country:US
Practice Address - Phone:516-255-3773
Practice Address - Fax:516-255-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2628422084P0804X, 261QM0801X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty