Provider Demographics
NPI: | 1720511140 |
---|---|
Name: | OHEL MEDICAL CARE PC |
Entity type: | Organization |
Organization Name: | OHEL MEDICAL CARE PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ALAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LEVENSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 718-686-3105 |
Mailing Address - Street 1: | 156 BEACH 9TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | FAR ROCKAWAY |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11691-5636 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-686-3105 |
Mailing Address - Fax: | 718-686-4105 |
Practice Address - Street 1: | 1268 E 14TH ST |
Practice Address - Street 2: | |
Practice Address - City: | BROOKLYN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11230-5241 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-686-3105 |
Practice Address - Fax: | 718-686-4105 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-04-04 |
Last Update Date: | 2017-04-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 208D00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty |