Provider Demographics
NPI:1285009464
Name:EPIC MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:EPIC MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARISE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GUADARRAMA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:631-526-9305
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWATERS
Mailing Address - State:NY
Mailing Address - Zip Code:11718-0614
Mailing Address - Country:US
Mailing Address - Phone:631-526-9305
Mailing Address - Fax:631-526-9306
Practice Address - Street 1:145 ORINOCO DR
Practice Address - Street 2:SUITE 614
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-3024
Practice Address - Country:US
Practice Address - Phone:631-526-9305
Practice Address - Fax:631-526-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care MedicineGroup - Multi-Specialty