Provider Demographics
NPI:1710432018
Name:PREVENTIVE MEDICAL CARE PC
Entity Type:Organization
Organization Name:PREVENTIVE MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:TCHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-745-0377
Mailing Address - Street 1:2043 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2110
Mailing Address - Country:US
Mailing Address - Phone:631-242-8488
Mailing Address - Fax:631-274-3505
Practice Address - Street 1:2043 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2110
Practice Address - Country:US
Practice Address - Phone:631-242-8488
Practice Address - Fax:631-274-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA130686171100000X
NY130686207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty