Provider Demographics
NPI:1073689600
Name:ADVANTAGE CARE DIAGNOSTIC AND TREATMENT CENTER ,INC
Entity Type:Organization
Organization Name:ADVANTAGE CARE DIAGNOSTIC AND TREATMENT CENTER ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHELE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-626-1075
Mailing Address - Street 1:189 WHEATLEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2641
Mailing Address - Country:US
Mailing Address - Phone:516-626-1075
Mailing Address - Fax:516-396-9766
Practice Address - Street 1:189 WHEATLEY RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:NY
Practice Address - Zip Code:11545
Practice Address - Country:US
Practice Address - Phone:516-626-1075
Practice Address - Fax:516-396-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02661801Medicaid
NYWEX501Medicare PIN