Provider Demographics
NPI:1154813137
Name:ACTIVE MEDICAL CARE PC
Entity Type:Organization
Organization Name:ACTIVE MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDNAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHEIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-593-5484
Mailing Address - Street 1:275 N MIDDLETOWN RD STE 1F
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1189
Mailing Address - Country:US
Mailing Address - Phone:914-376-6100
Mailing Address - Fax:914-231-6872
Practice Address - Street 1:275 N MIDDLETOWN RD STE 1F
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965
Practice Address - Country:US
Practice Address - Phone:914-376-6100
Practice Address - Fax:914-231-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical ToxicologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty