Healthcare Provider Details

I. General information

NPI: 1780457697
Provider Name (Legal Business Name): TOTAL MEDICAL 360 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 01/06/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 POST AVE UNIT A
WESTBURY NY
11590-3060
US

IV. Provider business mailing address

188 POST AVE UNIT A
WESTBURY NY
11590-3060
US

V. Phone/Fax

Practice location:
  • Phone: 516-477-9935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BIJU K JOSE
Title or Position: OWNER
Credential:
Phone: 516-477-9935