Provider Demographics
NPI:1538586771
Name:HEALTHY LIFE AND LONGEVITY MEDICAL OFFICE P.C.
Entity type:Organization
Organization Name:HEALTHY LIFE AND LONGEVITY MEDICAL OFFICE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZHICHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-579-6886
Mailing Address - Street 1:287 NORTHERN BOULEVARDS
Mailing Address - Street 2:SUIT 106
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4347
Mailing Address - Country:US
Mailing Address - Phone:917-579-6886
Mailing Address - Fax:
Practice Address - Street 1:287 NORTHERN BLVD
Practice Address - Street 2:SUIT 106
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4700
Practice Address - Country:US
Practice Address - Phone:917-579-6886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233928261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service