Provider Demographics
NPI:1225209778
Name:MEDICAL PROCARE, PLLC
Entity Type:Organization
Organization Name:MEDICAL PROCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-888-7728
Mailing Address - Street 1:13221 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5853
Mailing Address - Country:US
Mailing Address - Phone:718-888-7728
Mailing Address - Fax:718-888-7738
Practice Address - Street 1:13221 41ST AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5853
Practice Address - Country:US
Practice Address - Phone:718-888-7728
Practice Address - Fax:718-888-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203898174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01883870Medicaid
NY03291Medicare PIN
NY01883870Medicaid