Provider Demographics
NPI:1063637361
Name:CAMILLE PHILIPPE MD, PC
Entity Type:Organization
Organization Name:CAMILLE PHILIPPE MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-725-7031
Mailing Address - Street 1:16405 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4140
Mailing Address - Country:US
Mailing Address - Phone:718-658-2448
Mailing Address - Fax:718-658-2603
Practice Address - Street 1:16405 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4140
Practice Address - Country:US
Practice Address - Phone:718-658-2448
Practice Address - Fax:718-658-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY170899OtherGHI MEDICARE CHOICE
NY68861OtherMEDICARE-GHI
NY0068861OtherGHI
NY14714360NYOther1199 NATIONAL BENEFIT FUND
NY170899OtherCIGNA
NYDP163OtherOXFORD
NY170899OtherELDERPLAN
NY50013OtherVYTRA
58D471OtherEMPIRE BCBS
NY5C4094OtherHEALTHNET
NY147143B17OtherHEALTHFIRST
NY170899OtherAETNA
NY68861OtherGHI-MEDICARE
NY00924438Medicaid
NY147143OtherHIP
NY45817OtherGHI HMO
NYBKX033702OtherAMERICHOICE BY UNITED HEALTHCARE
NY08P5792OtherNEW YORK PRESBYTERIAN
NYBKX033702OtherAMERICHOICE BY UNITED HEALTHCARE