Basic Information
| Provider Information | |||||||||
| NPI: | 1659774107 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PROHEALTH CARE ASSOCIATES, LLP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DELLACORTE FOOTCARE - A DIVISION OF PROHEALTH CARE ASSOCIATES, LLP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 MARCUS AVENUE | ||||||||
| Address2: | |||||||||
| City: | LAKE SUCCESS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166226000 | ||||||||
| FaxNumber: | 5166082889 | ||||||||
| Practice Location | |||||||||
| Address1: | 59-01 69TH STREET | ||||||||
| Address2: | |||||||||
| City: | MASPETH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186393338 | ||||||||
| FaxNumber: | 7186395184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2014 | ||||||||
| LastUpdateDate: | 08/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | COOPER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5166226000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 003307 | NY | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 4930830001 | 01 | NY | DME | OTHER | W2L251 | 01 | NY | MEDICARE PTAN | OTHER |