Provider Demographics
NPI:1972797082
Name:NEW YORK URGENT CARE PC
Entity Type:Organization
Organization Name:NEW YORK URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAGDEEP
Authorized Official - Middle Name:J
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-461-2712
Mailing Address - Street 1:55 E OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4293
Mailing Address - Country:US
Mailing Address - Phone:516-605-0120
Mailing Address - Fax:
Practice Address - Street 1:55 E OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4293
Practice Address - Country:US
Practice Address - Phone:516-605-0120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227485261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400001701OtherMDCR INDIV PTAN
NYA100000238Medicare PIN
NYA400001701OtherMDCR INDIV PTAN