MEDICARE: LONG BEACH COMMUNITY HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	2908201R	NY

General Provider Information

NPI Number	:	1629094529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG BEACH COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	615 RIVERSIDE BLVD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2121
Country	:	US
Telephone Number	:	516-571-7795
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 RIVERSIDE BLVD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2121
Country	:	US
Telephone Number	:	516-571-7795
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	GARY BIE
Credential	:
Telephone Number	:	516-572-6711

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	04/08/2008

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Directions to “LONG BEACH COMMUNITY HEALTH CENTER ” Practice Location

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