Healthcare Provider Details

I. General information

NPI: 1285643650
Provider Name (Legal Business Name): PROHEALTH CARE ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 ROUTE 25A SUITE 106
SMITHTOWN NY
11787-1431
US

IV. Provider business mailing address

2800 MARCUS AVE
NEW HYDE PARK NY
11042-1113
US

V. Phone/Fax

Practice location:
  • Phone: 631-863-1007
  • Fax: 631-862-3668
Mailing address:
  • Phone: 516-622-6000
  • Fax: 516-622-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number089857
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID J COOPER
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 516-622-6000