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General NPI Number Information
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NPI Number | 1538586771
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE AND LONGEVITY MEDICAL OFFICE P.C.
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 287 NORTHERN BLVD SUIT 106
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City | GREAT NECK
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State | NY
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Zip | 11021-4700
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Country | US
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Telephone | 917-579-6886
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Fax |
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Provider Business Mailing Address
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Address Line | 287 NORTHERN BOULEVARDS SUIT 106
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City | GREAT NECK
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State | NY
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Zip | 11021-4347
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Country | US
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Telephone | 917-579-6886
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ZHICHENG LU
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Credential | D.O.
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Telephone | 917-579-6886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 233928
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License Number State | NY
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