Healthcare Provider Details

I. General information

NPI: 1992386064
Provider Name (Legal Business Name): ALPHACARE CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 06/05/2021
Certification Date: 06/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10526 WHEELHOUSE CIR
BOCA RATON FL
33428-1214
US

IV. Provider business mailing address

10526 WHEELHOUSE CIR
BOCA RATON FL
33428-1214
US

V. Phone/Fax

Practice location:
  • Phone: 516-462-6856
  • Fax: 855-727-7299
Mailing address:
  • Phone: 516-462-6856
  • Fax: 855-727-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LUDGER ELIACIN
Title or Position: PRESIDENT
Credential: DO
Phone: 516-462-6856