Provider Demographics
NPI:1770531220
Name:PRIME CARE MEDICAL OF LONG ISLAND, PC
Entity type:Organization
Organization Name:PRIME CARE MEDICAL OF LONG ISLAND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSENSTREICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-548-6470
Mailing Address - Street 1:240 W MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-3510
Mailing Address - Country:US
Mailing Address - Phone:631-728-4500
Mailing Address - Fax:631-728-4564
Practice Address - Street 1:240 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-3510
Practice Address - Country:US
Practice Address - Phone:631-728-4500
Practice Address - Fax:631-728-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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