Provider Demographics
NPI:1083698377
Name:IMMEDIATE MEDICAL CARE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:IMMEDIATE MEDICAL CARE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCUSI-UNGARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-488-6393
Mailing Address - Street 1:5700 W GENESEE ST
Mailing Address - Street 2:SUITE 100 SOUTH
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-3200
Mailing Address - Country:US
Mailing Address - Phone:315-488-6393
Mailing Address - Fax:315-488-5854
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:SUITE 100 SOUTH
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-488-6393
Practice Address - Fax:315-488-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY930066333OtherMEDICARE RAILROAD
NY930066334OtherMEDICARE RAILROAD
NY930066334OtherMEDICARE RAILROAD
NY5556510001Medicare NSC