Healthcare Provider Details

I. General information

NPI: 1629299516
Provider Name (Legal Business Name): LONG BEACH FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FRANKLIN BLVD APT 102
LONG BEACH NY
11561-4511
US

IV. Provider business mailing address

10 FRANKLIN BLVD APT 102
LONG BEACH NY
11561-4511
US

V. Phone/Fax

Practice location:
  • Phone: 516-889-0100
  • Fax:
Mailing address:
  • Phone: 516-889-0100
  • Fax: 516-897-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SERGEY KULIKOV
Title or Position: PRES.
Credential: D.O.
Phone: 516-889-0100