Healthcare Provider Details

I. General information

NPI: 1801762869
Provider Name (Legal Business Name): 21 EAST MARIE ST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 E MARIE ST
HICKSVILLE NY
11801-4303
US

IV. Provider business mailing address

21 E MARIE ST
HICKSVILLE NY
11801-4303
US

V. Phone/Fax

Practice location:
  • Phone: 516-236-6703
  • Fax:
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 State

VIII. Authorized Official

Name: MAYUR PAREKH
Title or Position: PRESIDENT
Credential:
Phone: 516-236-6703