Provider Demographics
NPI:1952513566
Name:WAINSCOTT WALK-IN MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:WAINSCOTT WALK-IN MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BLAKELEY
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-537-1892
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:WAINSCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:11975-1330
Mailing Address - Country:US
Mailing Address - Phone:631-537-1892
Mailing Address - Fax:631-537-3053
Practice Address - Street 1:83 WAINSCOTT NORTHWEST ROAD
Practice Address - Street 2:
Practice Address - City:WAINSCOTT
Practice Address - State:NY
Practice Address - Zip Code:11975-2003
Practice Address - Country:US
Practice Address - Phone:631-537-1892
Practice Address - Fax:631-537-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000291Medicare PIN