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General NPI Number Information
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NPI Number | 1700960440
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Entity Type | Organization
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Legal Business Name | PROHEALTH CARE ASSOCIATES, LLP
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 4045 HEMPSTEAD TPKE
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City | BETHPAGE
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State | NY
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Zip | 11714-5611
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Country | US
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Telephone | 516-731-7770
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Fax | 516-731-7059
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Provider Business Mailing Address
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Address Line | 1 DAKOTA DRIVE SUITE 320
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City | LAKE SUCCESS
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State | NY
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Zip | 11042
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Country | US
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Telephone | 516-622-6190
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Fax | 516-622-2914
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Authorized Official
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Title or Position | CEO, MANAGING PARTNER
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Name | DR. DAVID COOPER
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Credential | M.D.
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Telephone | 516-622-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 33D0156362
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License Number State | NY
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