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General NPI Number Information
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NPI Number | 1891858841
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Entity Type | Organization
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Legal Business Name | HEALTHY LIVING MEDICAL CARE PLLC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2742 BRIGHTON 8TH ST
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City | BROOKLYN
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State | NY
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Zip | 11235-5205
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Country | US
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Telephone | 718-300-7130
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Fax |
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Provider Business Mailing Address
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Address Line | 611 BANNER AVE APT 2C
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City | BROOKLYN
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State | NY
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Zip | 11235-6739
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Country | US
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Telephone | 718-300-7130
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | AHMED IRSHAD
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Credential |
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Telephone | 718-300-7130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 210766
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License Number State | NY
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