Provider Demographics
NPI:1558049577
Name:ISLAND WIDE MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:ISLAND WIDE MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:SUPPA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-636-5021
Mailing Address - Street 1:138 MAIN ST # 1009
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1702
Mailing Address - Country:US
Mailing Address - Phone:516-636-5021
Mailing Address - Fax:516-636-5023
Practice Address - Street 1:616 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5024
Practice Address - Country:US
Practice Address - Phone:516-636-5021
Practice Address - Fax:516-636-5023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty