Provider Demographics
NPI:1831971449
Name:HIGHLAND VALLEY MEDICAL CARE PLLC
Entity type:Organization
Organization Name:HIGHLAND VALLEY MEDICAL CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEK
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:631-413-4765
Mailing Address - Street 1:1797 VETERANS MEMORIAL HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1537
Mailing Address - Country:US
Mailing Address - Phone:631-413-4765
Mailing Address - Fax:
Practice Address - Street 1:369 MIDDLE COUNTRY RD STE 1
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3734
Practice Address - Country:US
Practice Address - Phone:631-413-4765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty