Healthcare Provider Details

I. General information

NPI: 1891219135
Provider Name (Legal Business Name): MASSAPEQUA CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LOUDEN AVE.
AMITYVILLE NY
11701-1705
US

IV. Provider business mailing address

101 LOUDEN AVE.
AMITYVILLE NY
11701-1705
US

V. Phone/Fax

Practice location:
  • Phone: 631-264-0222
  • Fax:
Mailing address:
  • Phone: 631-264-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: GERALD B FUCHS
Title or Position: COO
Credential:
Phone: 718-888-5200