Organization
LONGEVITY LONG TERM MEDICAL CARE OF PENNSYLVANIA PLLC
Active
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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