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General NPI Number Information
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NPI Number | 1467686949
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Entity Type | Organization
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Legal Business Name | SENIOR HEALTHCARE ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 1 SCHOOL ST SUITE 203
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City | GLEN COVE
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State | NY
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Zip | 11542-2545
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Country | US
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Telephone | 516-759-1776
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Fax | 516-671-9283
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Provider Business Mailing Address
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Address Line | 1 SCHOOL ST SUITE 203
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City | GLEN COVE
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State | NY
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Zip | 11542-2545
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Country | US
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Telephone | 516-759-1776
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Fax | 516-671-9283
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUIGI M CAPOBIANCO
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Credential | M.D.
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Telephone | 516-759-1776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 174738
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 174738
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 205804
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 174738
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License Number State | NY
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