Provider Demographics
NPI:1831450881
Name:OASIS MEDICAL CARE PC
Entity type:Organization
Organization Name:OASIS MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:HEROLD
Authorized Official - Last Name:ANCION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-204-9723
Mailing Address - Street 1:4213 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3011
Mailing Address - Country:US
Mailing Address - Phone:718-287-0868
Mailing Address - Fax:718-287-1375
Practice Address - Street 1:10418 220TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2145
Practice Address - Country:US
Practice Address - Phone:917-204-9723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100073445Medicare PIN