1528589389 NPI number — I CARE MEDICAL PLLC

Table of content: (NPI 1528589389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528589389 NPI number — I CARE MEDICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
I CARE MEDICAL PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528589389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1575 HILLSIDE AVE STE 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-2532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-775-8000
Provider Business Mailing Address Fax Number:
516-775-8001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1575 HILLSIDE AVE
Provider Second Line Business Practice Location Address:
302
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-775-8000
Provider Business Practice Location Address Fax Number:
516-775-8001
Provider Enumeration Date:
07/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
JUNG
Authorized Official First Name:
JOSEPHINE
Authorized Official Middle Name:
O
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-775-8000

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  199987 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 199987 . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10201894 . This is a "EMPIRE BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1316150 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 017244047 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132739694 . This is a "1199 SEIU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5271770 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1897650 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2696113 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3071837 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 199987-A31 . This is a "HEALTHFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9444405P01 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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