Provider Demographics
NPI:1235916255
Name:SACRED HEART PRIMARY CARE MEDICINE, PLLC
Entity Type:Organization
Organization Name:SACRED HEART PRIMARY CARE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GHECAS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:516-809-2500
Mailing Address - Street 1:700 OLD COUNTRY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4932
Mailing Address - Country:US
Mailing Address - Phone:516-809-2500
Mailing Address - Fax:
Practice Address - Street 1:700 OLD COUNTRY RD STE 105
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4932
Practice Address - Country:US
Practice Address - Phone:347-510-5866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty