| East Elmhurst Primary Medical Care, Pllc | |
|
2008 Seagirt Blvd Far Rockaway NY 11691-2803 | |
| (718) 565-6880 | |
| (877) 796-4457 |
| Full Name | East Elmhurst Primary Medical Care, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2008 Seagirt Blvd, Far Rockaway, New York |
| Authorized Official Name and Position | Eric Jones (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 7182339122 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Elmhurst Primary Medical Care, Pllc 2008 Seagirt Blvd Far Rockaway NY 11691-2803 Ph: (718) 565-6880 | East Elmhurst Primary Medical Care, Pllc 2008 Seagirt Blvd Far Rockaway NY 11691-2803 Ph: (718) 565-6880 |
| NPI Number | 1851347900 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 07/02/2024 |
| Medicare PECOS PAC ID | 1456622778 |
|---|---|
| Medicare Enrollment ID | O20170804002289 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851347900 | NPI | - | NPPES |
| 01454842 | Medicaid | NY | |
| 180270 | Other | NY | NYS MEDICAL LIC # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 180270 (New York) | Secondary |
| 207RS0012X | Internal Medicine - Sleep Medicine | 180270 (New York) | Primary |
| Provider Name | Robert D. Solomon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720050040 PECOS PAC ID: 5890780209 Enrollment ID: I20040415001272 |
| Provider Name | Mujibur R Majumder |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1316988165 PECOS PAC ID: 6709843659 Enrollment ID: I20041213000863 |
| Provider Name | Tinea White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992323422 PECOS PAC ID: 9133531338 Enrollment ID: I20201211001918 |
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