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Organization

LONGEVITY LONG TERM MEDICAL CARE OF PENNSYLVANIA PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DIANE VINCUR (PRACTICE MANAGER)
(561) 815-2427
Entity
Organization

Contact information

Practice address
2595 INTERSTATE DR STE 103, HARRISBURG, PA 17110-9378
(561) 815-2427
Mailing address
11770 US HIGHWAY 1 STE N107, PALM BEACH GARDENS, FL 33408-3027
(561) 815-2427

Taxonomy

Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
363LG0600X
Gerontology Nurse Practitioner
363LP2300X
Primary Care Nurse Practitioner

Other

Enumeration date
11/14/2022
Last updated
11/14/2022
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