Provider Demographics
NPI:1649369067
Name:SETAUKET PRIMARY MEDICAL CARE PC
Entity type:Organization
Organization Name:SETAUKET PRIMARY MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-941-4480
Mailing Address - Street 1:12 BREWSTER LN
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2922
Mailing Address - Country:US
Mailing Address - Phone:631-941-4480
Mailing Address - Fax:631-941-4054
Practice Address - Street 1:12 BREWSTER LN
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2922
Practice Address - Country:US
Practice Address - Phone:631-941-4480
Practice Address - Fax:631-941-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2278671207Q00000X
NY4893961363LF0000X
NYF334091363LF0000X
NYF3040001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDC2402OtherMEDICARE RAIL ROAD
NYDC2402OtherMEDICARE RAIL ROAD
NY=========OtherTAX ID