Provider Demographics
NPI:1356831309
Name:PURE MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:PURE MEDICAL SERVICES PC
Other - Org Name:PURE MEDICAL SERVICES PC
Other - Org Type:Other Name
Authorized Official - Title/Position:IC
Authorized Official - Prefix:MISS
Authorized Official - First Name:RENU
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:IC
Authorized Official - Phone:718-640-3960
Mailing Address - Street 1:79 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-2605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 N VILLAGE AVE STE 202
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:347-804-7277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty