Provider Demographics
NPI:1114080330
Name:FIRST CARE MEDICAL GROUP PC
Entity Type:Organization
Organization Name:FIRST CARE MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:LAIPING
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-882-3010
Mailing Address - Street 1:863 50TH STREET
Mailing Address - Street 2:SUITE M5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2417
Mailing Address - Country:US
Mailing Address - Phone:718-686-8880
Mailing Address - Fax:718-686-8891
Practice Address - Street 1:863 50TH STREET
Practice Address - Street 2:SUITE M5
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-686-8880
Practice Address - Fax:718-686-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213474208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty