Provider Demographics
NPI:1134832116
Name:OPTIMUM CARE FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:OPTIMUM CARE FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPSALIS-RAMBALAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-265-4609
Mailing Address - Street 1:321 E MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2820
Mailing Address - Country:US
Mailing Address - Phone:631-265-4606
Mailing Address - Fax:631-265-4675
Practice Address - Street 1:321 E MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2820
Practice Address - Country:US
Practice Address - Phone:631-265-4606
Practice Address - Fax:631-265-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty