Provider Demographics
NPI:1184664641
Name:RONKONKOMA MEDICAL CARE, PLLC
Entity Type:Organization
Organization Name:RONKONKOMA MEDICAL CARE, PLLC
Other - Org Name:COMMACK MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEENA
Authorized Official - Middle Name:SAMIR
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-462-2993
Mailing Address - Street 1:2171 JERICHO TPKE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2915
Mailing Address - Country:US
Mailing Address - Phone:631-462-2993
Mailing Address - Fax:631-462-2995
Practice Address - Street 1:2171 JERICHO TPKE
Practice Address - Street 2:SUITE 304
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2915
Practice Address - Country:US
Practice Address - Phone:631-462-2993
Practice Address - Fax:631-462-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID
NY=========OtherTAX ID