Provider Demographics
NPI:1598134488
Name:COUNTRY WIDE MEDICAL SERVICES P.C.
Entity Type:Organization
Organization Name:COUNTRY WIDE MEDICAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-984-5834
Mailing Address - Street 1:1979 MARCUS AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1022
Mailing Address - Country:US
Mailing Address - Phone:516-326-7772
Mailing Address - Fax:
Practice Address - Street 1:13177 234TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1311
Practice Address - Country:US
Practice Address - Phone:718-527-1246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty