Provider Demographics
NPI:1760880439
Name:PRIMACARE MEDICAL GROUP, PC.
Entity Type:Organization
Organization Name:PRIMACARE MEDICAL GROUP, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ION
Authorized Official - Middle Name:
Authorized Official - Last Name:OLTEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-963-3350
Mailing Address - Street 1:62 SEASONGOOD RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6033
Mailing Address - Country:US
Mailing Address - Phone:718-963-3350
Mailing Address - Fax:718-963-0494
Practice Address - Street 1:62 SEASONGOOD RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6033
Practice Address - Country:US
Practice Address - Phone:718-963-3350
Practice Address - Fax:718-963-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty