| Provident Health Partners Inc. | |
|
1529 N Ocean Ave Ste A Medford NY 11763-3587 | |
| (631) 266-4501 | |
| (631) 266-4502 |
| Full Name | Provident Health Partners Inc. |
|---|---|
| Speciality | Clinic/center |
| Location | 1529 N Ocean Ave Ste A, Medford, New York |
| Authorized Official Name and Position | Jennifer Desousa (ADMINISTRATOR) |
| Authorized Official Contact | 6312664501 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provident Health Partners Inc. 554 Larkfield Rd Ste 207 East Northport NY 11731-4205 Ph: (631) 266-4501 | Provident Health Partners Inc. 1529 N Ocean Ave Ste A Medford NY 11763-3587 Ph: (631) 266-4501 |
| NPI Number | 1275157000 |
|---|---|
| Provider Enumeration Date | 06/08/2020 |
| Last Update Date | 06/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275157000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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