Healthcare Provider Details

I. General information

NPI: 1669975033
Provider Name (Legal Business Name): HOME MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 GRAND CENTRAL AVE
AMITYVILLE NY
11701-3749
US

IV. Provider business mailing address

56 GRAND CENTRAL AVE
AMITYVILLE NY
11701-3749
US

V. Phone/Fax

Practice location:
  • Phone: 631-264-2788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number136115
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD LESLIE COVEN
Title or Position: PRESIDENT
Credential:
Phone: 631-264-2788