Healthcare Provider Details

I. General information

NPI: 1134092836
Provider Name (Legal Business Name): 120 AND BEYOND SOCIAL ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MIDDLE NECK RD
GREAT NECK NY
11024-1932
US

IV. Provider business mailing address

801 MIDDLE NECK RD
GREAT NECK NY
11024-1932
US

V. Phone/Fax

Practice location:
  • Phone: 516-718-3120
  • Fax: 516-718-7120
Mailing address:
  • Phone:
  • 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: PINHAS A TAVAKOLY
Title or Position: CEO
Credential:
Phone: 516-718-3120