Provider Demographics
NPI:1164602090
Name:FASTCARE FAMILY MEDICAL, PC
Entity Type:Organization
Organization Name:FASTCARE FAMILY MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DILIP
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-598-8224
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:4350 MIDDLE SETTLEMENT RD SUITE C
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-0340
Mailing Address - Country:US
Mailing Address - Phone:315-732-9368
Mailing Address - Fax:315-732-9403
Practice Address - Street 1:120 CAYUGA ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1742
Practice Address - Country:US
Practice Address - Phone:315-598-8224
Practice Address - Fax:315-598-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216564-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02116172Medicaid
NY02116172Medicaid