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General NPI Number Information
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NPI Number | 1578066015
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Entity Type | Organization
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Legal Business Name | LIFELONG MEDICAL DIAGNOSTICS PC
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 1460 W 5TH ST STE M1
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City | BROOKLYN
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State | NY
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Zip | 11204-4071
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Country | US
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Telephone | 718-234-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 3165 EMMONS AVE APT 1K
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City | BROOKLYN
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State | NY
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Zip | 11235-1790
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Country | US
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Telephone | 718-234-2233
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Fax |
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Authorized Official
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Title or Position | MD
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Name | YEVGENY LITVAK
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Credential | MD
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Telephone | 718-234-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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