Healthcare Provider Details

I. General information

NPI: 1811316516
Provider Name (Legal Business Name): EG CARE MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 BURRS LN
DIX HILLS NY
11746-6052
US

IV. Provider business mailing address

143 BURRS LN
DIX HILLS NY
11746-6052
US

V. Phone/Fax

Practice location:
  • Phone: 631-643-4400
  • Fax:
Mailing address:
  • Phone: 631-643-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY DE SESA
Title or Position: OWNER
Credential:
Phone: 631-643-4400