Provider Demographics
NPI:1912033184
Name:PRIME QUALITY MEDICAL CARE PC
Entity Type:Organization
Organization Name:PRIME QUALITY MEDICAL CARE PC
Other - Org Name:PRIME CARE MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BALIKCIOGLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:718-265-5858
Mailing Address - Street 1:1645 E 19TH ST PH
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1311
Mailing Address - Country:US
Mailing Address - Phone:718-265-5858
Mailing Address - Fax:718-265-2306
Practice Address - Street 1:1645 E 19TH ST PH
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1311
Practice Address - Country:US
Practice Address - Phone:718-265-5858
Practice Address - Fax:718-265-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05320Medicare ID - Type Unspecified