Healthcare Provider Details

I. General information

NPI: 1699297929
Provider Name (Legal Business Name): EXTENDED CARE PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 CAMELOT DR
VIRGINIA BEACH VA
23454-2401
US

IV. Provider business mailing address

3816 OLD SHELL RD
VIRGINIA BEACH VA
23452-4723
US

V. Phone/Fax

Practice location:
  • Phone: 516-220-5760
  • Fax:
Mailing address:
  • Phone: 516-220-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEX ZAWOLOKA
Title or Position: PRESIDENT
Credential: MD
Phone: 516-220-5760