Healthcare Provider Details

I. General information

NPI: 1699299925
Provider Name (Legal Business Name): BELLEVUE JOSEPH ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 MARSHALL COURT
UNIONDALE NY
11553
US

IV. Provider business mailing address

496 MARSHALL CT
UNIONDALE NY
11553-2112
US

V. Phone/Fax

Practice location:
  • Phone: 516-410-7584
  • Fax:
Mailing address:
  • Phone: 516-410-7584
  • 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: MR. CALVIN D. PAUL
Title or Position: FOUNDER
Credential:
Phone: 516-410-7584