Provider Demographics
NPI:1265544936
Name:BIG FLATS PRIMARY CARE
Entity type:Organization
Organization Name:BIG FLATS PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:POVANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:607-562-3000
Mailing Address - Street 1:455 MAPLE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BIG FLATS
Mailing Address - State:NY
Mailing Address - Zip Code:14814-9701
Mailing Address - Country:US
Mailing Address - Phone:607-562-3600
Mailing Address - Fax:607-562-8661
Practice Address - Street 1:455 MAPLE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BIG FLATS
Practice Address - State:NY
Practice Address - Zip Code:14814-9701
Practice Address - Country:US
Practice Address - Phone:607-562-3600
Practice Address - Fax:607-562-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195749261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00363126Medicaid
NYF83610Medicare UPIN
NYR70080Medicare ID - Type Unspecified