Provider Demographics
NPI:1265852800
Name:IMMEDIATE CARE MEDICAL WALK-IN OF BENSONHURST, PC
Entity Type:Organization
Organization Name:IMMEDIATE CARE MEDICAL WALK-IN OF BENSONHURST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ESMAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAROBEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-335-9400
Mailing Address - Street 1:6906 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6906 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5048
Practice Address - Country:US
Practice Address - Phone:732-335-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE URGENT CARE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-22
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care