Provider Demographics
NPI:1912244567
Name:ACTIVE CARE PHYSICIAN PC
Entity Type:Organization
Organization Name:ACTIVE CARE PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLANCHE
Authorized Official - Middle Name:SAU
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-343-8290
Mailing Address - Street 1:70 BOWERY
Mailing Address - Street 2:SUITE 404
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4607
Mailing Address - Country:US
Mailing Address - Phone:212-343-8290
Mailing Address - Fax:212-343-8328
Practice Address - Street 1:70 BOWERY
Practice Address - Street 2:SUITE 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4607
Practice Address - Country:US
Practice Address - Phone:212-343-8290
Practice Address - Fax:212-343-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213122207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty