Healthcare Provider Details

I. General information

NPI: 1194055939
Provider Name (Legal Business Name): CENTERLIGHT HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13665 37TH AVE
FLUSHING NY
11354-4110
US

IV. Provider business mailing address

13665 37TH AVE
FLUSHING NY
11354-4110
US

V. Phone/Fax

Practice location:
  • Phone: 833-252-2737
  • Fax:
Mailing address:
  • Phone: 833-252-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: ERIN LIBERTI
Title or Position: VP. PROVIDER RELATIONS
Credential:
Phone: 917-828-7701