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General NPI Number Information
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NPI Number | 1699297929
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Entity Type | Organization
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Legal Business Name | EXTENDED CARE PHYSICIANS LLC
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 07/07/2017
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Provider Practice Location Address
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Address Line | 1801 CAMELOT DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2401
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Country | US
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Telephone | 516-220-5760
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Fax |
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Provider Business Mailing Address
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Address Line | 3816 OLD SHELL RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4723
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Country | US
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Telephone | 516-220-5760
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEX ZAWOLOKA
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Credential | MD
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Telephone | 516-220-5760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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