Provider Demographics
NPI:1558592147
Name:WILLIAM C. PADULA MD PC
Entity Type:Organization
Organization Name:WILLIAM C. PADULA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:COSMO
Authorized Official - Last Name:PADULA
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:631-789-2020
Mailing Address - Street 1:5240 MERRICK RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6207
Mailing Address - Country:US
Mailing Address - Phone:516-798-2200
Mailing Address - Fax:516-798-3242
Practice Address - Street 1:5240 MERRICK RD
Practice Address - Street 2:SUITE #2
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6207
Practice Address - Country:US
Practice Address - Phone:516-798-2200
Practice Address - Fax:516-798-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00429263Medicaid
NY1205949518OtherNPI
AP3437414OtherDEA
NYB07644Medicare UPIN
NY00429263Medicaid