Provider Demographics
NPI:1811138415
Name:MEDICAL CARE AT HOME PC
Entity type:Organization
Organization Name:MEDICAL CARE AT HOME PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF MEDICAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-760-3102
Mailing Address - Street 1:220 E 42ND STREET, 6TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5831
Mailing Address - Country:US
Mailing Address - Phone:212-946-9258
Mailing Address - Fax:646-524-8323
Practice Address - Street 1:220 E 42ND STREET, 6TH FLOOR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5831
Practice Address - Country:US
Practice Address - Phone:212-946-9258
Practice Address - Fax:646-524-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179894-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03219270Medicaid
NY3219270Medicaid
NY03219270Medicaid
J100010201Medicare PIN