Healthcare Provider Details

I. General information

NPI: 1629094529
Provider Name (Legal Business Name): LONG BEACH COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 RIVERSIDE BLVD
LONG BEACH NY
11561-2121
US

IV. Provider business mailing address

615 RIVERSIDE BLVD
LONG BEACH NY
11561-2121
US

V. Phone/Fax

Practice location:
  • Phone: 516-571-7795
  • Fax:
Mailing address:
  • Phone: 516-571-7795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2908201R
License Number StateNY

VIII. Authorized Official

Name: GARY BIE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 516-572-6711