Provider Demographics
NPI:1083020242
Name:RIMISAC FAMILY HEALTH NP PC
Entity Type:Organization
Organization Name:RIMISAC FAMILY HEALTH NP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASIMIR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:347-495-5216
Mailing Address - Street 1:14036 170TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4632
Mailing Address - Country:US
Mailing Address - Phone:347-495-5216
Mailing Address - Fax:
Practice Address - Street 1:14036 170TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4632
Practice Address - Country:US
Practice Address - Phone:347-495-5216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
NY336140261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03299709Medicaid
A400033002OtherMEDICARE