Healthcare Provider Details

I. General information

NPI: 1700960440
Provider Name (Legal Business Name): PROHEALTH CARE ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 HEMPSTEAD TPKE
BETHPAGE NY
11714-5611
US

IV. Provider business mailing address

1 DAKOTA DRIVE SUITE 320
LAKE SUCCESS NY
11042
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-7770
  • Fax: 516-731-7059
Mailing address:
  • Phone: 516-622-6190
  • Fax: 516-622-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number33D0156362
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID COOPER
Title or Position: CEO, MANAGING PARTNER
Credential: M.D.
Phone: 516-622-6000