1154548329 NPI number — A&M ADVANCED MEDICAL CARE PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154548329 NPI number — A&M ADVANCED MEDICAL CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A&M ADVANCED MEDICAL CARE PC
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:
1154548329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 OCEANA DR E
Provider Second Line Business Mailing Address:
PENTHOUSE 2B
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11235-6668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-743-6124
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6260 108TH ST
Provider Second Line Business Practice Location Address:
SUITE 1J
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-1356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-275-2224
Provider Business Practice Location Address Fax Number:
718-275-5100
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ADELMAN
Authorized Official First Name:
MARINA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING DEPARTMENT
Authorized Official Telephone Number:
718-743-7090

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  231544 , 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: 02554805 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com