Provider Demographics
NPI:1801238845
Name:PREMIER CARE MEDICAL OF WEST ISLIP, PLLC
Entity type:Organization
Organization Name:PREMIER CARE MEDICAL OF WEST ISLIP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-783-4600
Mailing Address - Street 1:2459 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5703
Mailing Address - Country:US
Mailing Address - Phone:516-783-4600
Mailing Address - Fax:516-783-4612
Practice Address - Street 1:292 HERRICKS RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1119
Practice Address - Country:US
Practice Address - Phone:516-292-8910
Practice Address - Fax:516-292-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care