Healthcare Provider Details

I. General information

NPI: 1922031905
Provider Name (Legal Business Name): LIFECO MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7035 113TH ST
FOREST HILLS NY
11375-4651
US

IV. Provider business mailing address

PO BOX 32635
HARTFORD CT
06150-2635
US

V. Phone/Fax

Practice location:
  • Phone: 718-423-0808
  • Fax:
Mailing address:
  • Phone: 718-423-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNY

VIII. Authorized Official

Name: ROBERT J AQUINO
Title or Position: PRESIDENT
Credential: MD
Phone: 718-423-0808