Provider Demographics
NPI:1912094426
Name:BRIMS, PATRICIA J (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:BRIMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:JOSEPHINE
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:1 MARTINGALE GATE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-3546
Mailing Address - Country:US
Mailing Address - Phone:201-208-4286
Mailing Address - Fax:
Practice Address - Street 1:2780 MIDDLE COUNTRY RD STE 140
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2120
Practice Address - Country:US
Practice Address - Phone:631-580-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010992363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010992OtherNY STATE LICENSE
146534RZGMedicare UPIN