Provider Demographics
NPI:1588675466
Name:ISLAND URGENT MEDICAL CARE, P.C.
Entity Type:Organization
Organization Name:ISLAND URGENT MEDICAL CARE, P.C.
Other - Org Name:BROOK FAMILY MEDICINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:FERRARA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-514-7606
Mailing Address - Street 1:1228 EAST MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-603-3400
Mailing Address - Fax:631-603-3401
Practice Address - Street 1:1228 EAST MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-603-3400
Practice Address - Fax:631-603-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY215053207Q00000X
NY170935261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWT481Medicare PIN
NYH34115Medicare UPIN