Provider Demographics
NPI:1003963026
Name:IMMEDIATE FAMILY CARE, LLC
Entity Type:Organization
Organization Name:IMMEDIATE FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-968-0800
Mailing Address - Street 1:41 BRENTWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6924
Mailing Address - Country:US
Mailing Address - Phone:631-968-0800
Mailing Address - Fax:631-665-0816
Practice Address - Street 1:41 BRENTWOOD ROAD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6924
Practice Address - Country:US
Practice Address - Phone:631-968-0800
Practice Address - Fax:631-665-0816
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMMEDIATE FAMILY CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-04
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150415173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100001493Medicare UPIN