1326265885 NPI number — EXECUTIVE MEDICAL CARE,P.C.

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 1326265885 NPI number — EXECUTIVE MEDICAL CARE,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXECUTIVE MEDICAL CARE,P.C.
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:
1326265885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 GOODALL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10308-3396
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-270-8647
Provider Business Mailing Address Fax Number:
718-891-7542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3049 BRIGHTON 6TH STREET
Provider Second Line Business Practice Location Address:
UNIT CU 1
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-6409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-934-0322
Provider Business Practice Location Address Fax Number:
718-934-0994
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LUGINA
Authorized Official First Name:
SERGEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT , MEDICAL DIRECTOR
Authorized Official Telephone Number:
646-270-8647

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 222476 , 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)





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