Provider Demographics
NPI:1508993650
Name:MEDCARE, LLC
Entity Type:Organization
Organization Name:MEDCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SOFIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEISSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-399-6234
Mailing Address - Street 1:468 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4809
Mailing Address - Country:US
Mailing Address - Phone:718-399-6234
Mailing Address - Fax:718-399-3516
Practice Address - Street 1:468 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4809
Practice Address - Country:US
Practice Address - Phone:718-399-6234
Practice Address - Fax:718-399-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006926152W00000X
NY219313207Q00000X
NY218384207R00000X
NY127692207RC0000X
NY174588207RE0101X
NY233517207V00000X
NYN006039213E00000X
NY026957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03010506Medicaid
NY03010506Medicaid
NYWWS861Medicare PIN