Provider Demographics
NPI:1831736602
Name:LL PHYSICIAN ASSISTANT PC
Entity type:Organization
Organization Name:LL PHYSICIAN ASSISTANT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PA-C
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:LITOVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:917-575-1144
Mailing Address - Street 1:452 SLOSSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5445
Mailing Address - Country:US
Mailing Address - Phone:917-575-1144
Mailing Address - Fax:
Practice Address - Street 1:2279 CONEY ISLAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3337
Practice Address - Country:US
Practice Address - Phone:718-998-9890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty