Provider Demographics
NPI: | 1376873117 |
---|---|
Name: | LONG ISLAND PROMPT CARE INC |
Entity Type: | Organization |
Organization Name: | LONG ISLAND PROMPT CARE INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANDREW |
Authorized Official - Middle Name: | FOX |
Authorized Official - Last Name: | WILLIAMS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 347-429-2845 |
Mailing Address - Street 1: | 315 BLEECKER ST |
Mailing Address - Street 2: | STE 376 |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10014-3427 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 347-429-2845 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 694 8TH AVE |
Practice Address - Street 2: | RM 203 |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10036-7100 |
Practice Address - Country: | US |
Practice Address - Phone: | 347-429-2845 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-12-29 |
Last Update Date: | 2009-12-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 234927 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty |