# LONGEVITY LONG TERM MEDICAL CARE OF NEW YORK, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881345650
- **Authorized official:** DIANE VINCUR (CLINICAL SUPPORT TALENT SPECIALIST)
- **Authorized official phone:** (561) 815-2427

## Contact information

- **Practice address:** 485 MADISON AVE STE 202, NEW YORK, NY 10022-5878
- **Practice address phone:** (888) 885-7337
- **Mailing address:** 11770 US HIGHWAY 1 STE 102E, PALM BEACH GARDENS, FL 33408-3052
- **Mailing address phone:** (561) 815-2427

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | NULL | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/13/2022
- **Last updated:** 01/13/2022