NPIMap

Organization Active NPI

LTC Provider Management Corp

  • Skilled Nursing Facility
  • Port Washington, NY
National Provider Identifier
1346694502
Registry record updated Mar 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
129224 Issued in NY
Legal business name
LTC PROVIDER MANAGEMENT CORP
Practice address
30 Wood Rd
Port Washington, NY 11050-2625
Phone
(516) 652-7647
Fax
(516) 944-2385
NPI assigned
Apr 14, 2016
Last updated
Mar 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Myles Edward Gombert, M.D.NPI 1326109091
Title
President
Phone
(516) 652-7647

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 129224 NY Primary

Addresses

Primary practice location

30 Wood Rd
Port Washington, NY 11050-2625

Mailing address

30 Wood Rd
Port Washington, NY 11050-2625
Phone (516) 652-7647

Other identifiers 1

IdentifierTypeStateIssuer
45A201OtherNYPTAN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490572800000",
    "number": "1346694502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 WOOD RD",
            "city": "PORT WASHINGTON",
            "state": "NY",
            "postal_code": "110502625",
            "telephone_number": "516-652-7647",
            "fax_number": "516-944-2385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 WOOD RD",
            "city": "PORT WASHINGTON",
            "state": "NY",
            "postal_code": "110502625",
            "telephone_number": "516-652-7647",
            "fax_number": "516-944-2385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTC PROVIDER MANAGEMENT CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-14",
        "last_updated": "2017-03-27",
        "status": "A",
        "authorized_official_last_name": "GOMBERT",
        "authorized_official_first_name": "MYLES",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-652-7647",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "129224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "45A201",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Washington, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.