Healthcare Provider Details

I. General information

NPI: 1447766449
Provider Name (Legal Business Name): LICURA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 W HARTSDALE AVE STE 203A
WHITE PLAINS NY
10607-1847
US

IV. Provider business mailing address

20220 BOCA WEST DR APT 1004
BOCA RATON FL
33434-4717
US

V. Phone/Fax

Practice location:
  • Phone: 914-966-4305
  • Fax:
Mailing address:
  • Phone: 561-900-6382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD STEVEN FLORSHEIM
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 561-900-6382