Provider Demographics
NPI:1225256365
Name:DAVID IMMANUEL, MD, PC
Entity Type:Organization
Organization Name:DAVID IMMANUEL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:IMMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:516-565-2095
Mailing Address - Street 1:230 HILTON AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-8115
Mailing Address - Country:US
Mailing Address - Phone:516-565-2095
Mailing Address - Fax:516-565-2080
Practice Address - Street 1:230 HILTON AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8115
Practice Address - Country:US
Practice Address - Phone:516-565-2095
Practice Address - Fax:516-565-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231402207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02552734Medicaid
NY469B01Medicare ID - Type UnspecifiedMEDICARE
NYH88269Medicare UPIN