MEDICARE: NY LONG-TERM CARE PHYSICIAN SERVICES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1477121549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY LONG-TERM CARE PHYSICIAN SERVICES, PC

Provider Business Mailing Address
First Line	:	PO BOX 639676
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-9676
Country	:	US
Telephone Number	:	859-291-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 HEMPSTEAD TPKE
Second Line	:
City	:	UNIONDALE
State	:	NY
Zip	:	11553-1111
Country	:	US
Telephone Number	:	516-565-1900
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/AUTHORIZED OFFICIAL
Name	:	JILL FORD
Credential	:
Telephone Number	:	859-291-4800

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	02/25/2026

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