Province Therapeutics, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROVINCE THERAPEUTICS, LLC

Practice address

11835 Queens Blvd
Suite 400
Forest Hills, NY 11375-7200

Phone

(631) 827-9189

NPI assigned

Mar 4, 2015

Organization subpart

No

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

Authorized official

Name

Ashley E Patrick

Title

Owner

Phone

(631) 827-9189

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490227200000",
    "number": "1801288568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11835 QUEENS BLVD",
            "address_2": "SUITE 400",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11835 QUEENS BLVD",
            "address_2": "SUITE 400",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757200",
            "telephone_number": "631-827-9189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVINCE THERAPEUTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-04",
        "last_updated": "2017-03-23",
        "status": "A",
        "authorized_official_last_name": "PATRICK",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-827-9189"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Community/Behavioral Health Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.