Provider Demographics
NPI:1215003108
Name:PEDIATRIC IMMEDIATE CARE,PLLC
Entity Type:Organization
Organization Name:PEDIATRIC IMMEDIATE CARE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:URSZULA
Authorized Official - Middle Name:KRYSTYNA
Authorized Official - Last Name:RAKOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FAAP,MBA,CPE
Authorized Official - Phone:631-956-3537
Mailing Address - Street 1:150 SUNRISE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2598
Mailing Address - Country:US
Mailing Address - Phone:631-956-3537
Mailing Address - Fax:631-956-7086
Practice Address - Street 1:150 SUNRISE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2598
Practice Address - Country:US
Practice Address - Phone:631-956-3537
Practice Address - Fax:631-956-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205268208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG78533Medicare UPIN