Provider Demographics
NPI:1841557378
Name:PRIMARY CARE FAMILY DOCTOR P.C.
Entity Type:Organization
Organization Name:PRIMARY CARE FAMILY DOCTOR P.C.
Other - Org Name:PRIMARY CARE FAMILY DOCTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:BASOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:631-849-4551
Mailing Address - Street 1:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-0383
Mailing Address - Country:US
Mailing Address - Phone:631-849-4551
Mailing Address - Fax:631-849-4552
Practice Address - Street 1:565 ROUTE 25A STE 101
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2600
Practice Address - Country:US
Practice Address - Phone:631-849-4551
Practice Address - Fax:631-849-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty