Ltc Provider Management Corp
NPI #1346694502 in Port Washington, New York
Provider Information
- NPI Number
- 1346694502
- Entity Type
- Organization
- Organization Name
- Ltc Provider Management Corp
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Apr 14, 2016
- Last Updated
- Mar 27, 2017
Practice Location
- Address
- 30 WOOD RD
- City
- Port Washington
- State
- New York
- ZIP Code
- 11050-2625
- Phone
- (516) 652-7647
Authorized Official
- Name
- DR. MYLES EDWARD GOMBERT, M.D.
- Title
- PRESIDENT
- Phone
- (516) 652-7647
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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