Provider Demographics
NPI:1275673089
Name:FAMILY CARE CENTER
Entity Type:Organization
Organization Name:FAMILY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITZI
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-469-8492
Mailing Address - Street 1:941 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6715
Mailing Address - Country:US
Mailing Address - Phone:718-469-8492
Mailing Address - Fax:
Practice Address - Street 1:941 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6715
Practice Address - Country:US
Practice Address - Phone:718-469-8492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100027817201OtherUNITED HEALTHCARE
NYBKX033002OtherAMERICHOICE OF NEW YORK
NYP3507562Other0XFORD HEALTH PLAN
NY5996296OtherGHI
NYP3507562Other0XFORD HEALTH PLAN
NY89D531Medicare ID - Type Unspecified