Provider Demographics
NPI:1538698642
Name:MEDICAL CARE FOR ALL PC
Entity Type:Organization
Organization Name:MEDICAL CARE FOR ALL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-945-8134
Mailing Address - Street 1:1180 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3649
Mailing Address - Country:US
Mailing Address - Phone:212-945-8134
Mailing Address - Fax:888-908-8284
Practice Address - Street 1:22 E 41ST ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6280
Practice Address - Country:US
Practice Address - Phone:212-945-8134
Practice Address - Fax:212-558-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03264646Medicaid