Provider Demographics
NPI:1326446204
Name:PROMPT MEDICAL SPINE CARE
Entity Type:Organization
Organization Name:PROMPT MEDICAL SPINE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-355-9819
Mailing Address - Street 1:2001 MARCUS AVE STE W170
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2042
Mailing Address - Country:US
Mailing Address - Phone:516-355-9819
Mailing Address - Fax:516-355-9420
Practice Address - Street 1:2001 MARCUS AVE STE W170
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2042
Practice Address - Country:US
Practice Address - Phone:516-355-9819
Practice Address - Fax:516-355-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2616041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty