Provider Demographics
NPI:1912071986
Name:ON CALL MEDICAL PC
Entity Type:Organization
Organization Name:ON CALL MEDICAL PC
Other - Org Name:MORICHES MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-878-2222
Mailing Address - Street 1:504B MONTAWK HWY
Mailing Address - Street 2:
Mailing Address - City:CENTER MONCHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934
Mailing Address - Country:US
Mailing Address - Phone:631-878-2222
Mailing Address - Fax:631-878-4129
Practice Address - Street 1:504B MONTAWK HWY
Practice Address - Street 2:
Practice Address - City:CENTER MONCHES
Practice Address - State:NY
Practice Address - Zip Code:11934
Practice Address - Country:US
Practice Address - Phone:631-878-2222
Practice Address - Fax:631-878-4129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B78634Medicare UPIN
MS065A3930Medicare ID - Type Unspecified