Provider Demographics
NPI:1861486268
Name:PRIME CARE MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:PRIME CARE MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-447-0093
Mailing Address - Street 1:25 CORPORATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742
Mailing Address - Country:US
Mailing Address - Phone:631-447-0093
Mailing Address - Fax:631-447-0148
Practice Address - Street 1:25 CORPORATE DRIVE
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742
Practice Address - Country:US
Practice Address - Phone:631-447-0093
Practice Address - Fax:631-447-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00706698Medicaid
NY00706698Medicaid
0225940001Medicare NSC