Provider Demographics
NPI:1619053071
Name:PROCARE MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:PROCARE MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAI-KUEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-888-9202
Mailing Address - Street 1:13630 MAPLE AVE
Mailing Address - Street 2:SUITE 2L
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3868
Mailing Address - Country:US
Mailing Address - Phone:718-888-9202
Mailing Address - Fax:718-888-9204
Practice Address - Street 1:13630 MAPLE AVE
Practice Address - Street 2:SUITE 2L
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3868
Practice Address - Country:US
Practice Address - Phone:718-888-9202
Practice Address - Fax:718-888-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03304074Medicaid
NY05800Medicare PIN