Organization
PROVIDENT HEALTH PARTNERS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER DESOUSA (ADMINISTRATOR)
(631) 266-4501
Entity
Organization
Contact information
Practice address
1529 N OCEAN AVE STE A, MEDFORD, NY 11763-3587
(631) 266-4501
(631) 266-4502
Mailing address
554 LARKFIELD RD STE 207, EAST NORTHPORT, NY 11731-4205
(631) 266-4501
(631) 266-4502
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
06/08/2020
Last updated
06/08/2020
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