Healthcare Provider Details

I. General information

NPI: 1811935943
Provider Name (Legal Business Name): PROHEALTH CARE ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 E MAIN ST
RIVERHEAD NY
11901-2564
US

IV. Provider business mailing address

937 E MAIN ST
RIVERHEAD NY
11901-2564
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-0777
  • Fax: 631-369-0976
Mailing address:
  • Phone: 631-369-0777
  • Fax: 631-369-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY DEMMERLE
Title or Position: PRACTICE MNGR
Credential:
Phone: 516-593-1380