Provider Demographics
NPI:1548896814
Name:ADVANCED LUNG CARE PLLC
Entity type:Organization
Organization Name:ADVANCED LUNG CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-621-5042
Mailing Address - Street 1:2557 GLENN DR
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5027
Mailing Address - Country:US
Mailing Address - Phone:917-621-5042
Mailing Address - Fax:516-517-9515
Practice Address - Street 1:134 GREAT EAST NECK RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-8027
Practice Address - Country:US
Practice Address - Phone:917-621-5042
Practice Address - Fax:516-517-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY095090OtherLICENSE