| Heritage New York Medical Pc | |
|
501 Franklin Ave Ste. 140 Garden City NY 11530-5807 | |
| (516) 531-2001 | |
| Not Available |
| Full Name | Heritage New York Medical Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 501 Franklin Ave, Garden City, New York |
| Authorized Official Name and Position | Mary Kathleen Nix (CEO) |
| Authorized Official Contact | 5165312107 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage New York Medical Pc 501 Franklin Ave Ste. 140 Garden City NY 11530-5807 Ph: (516) 531-2001 | Heritage New York Medical Pc 501 Franklin Ave Ste. 140 Garden City NY 11530-5807 Ph: (516) 531-2001 |
| NPI Number | 1578982146 |
|---|---|
| Provider Enumeration Date | 04/10/2014 |
| Last Update Date | 11/15/2016 |
| Medicare PECOS PAC ID | 5991922643 |
|---|---|
| Medicare Enrollment ID | O20140804002243 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578982146 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 364S00000X | Clinical Nurse Specialist | 11-3284153 (New York) | Secondary |
| Provider Name | Michelle Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316353162 PECOS PAC ID: 8921318098 Enrollment ID: I20151103000631 |
| Provider Name | Anastasia Fontana |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790956399 PECOS PAC ID: 2264778273 Enrollment ID: I20190112000043 |
| Provider Name | Christine Kathy Charles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851911788 PECOS PAC ID: 9335570563 Enrollment ID: I20200504000607 |
| Provider Name | Terreca Annmarie Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427665207 PECOS PAC ID: 3375983109 Enrollment ID: I20240426002693 |
| Provider Name | Diane Lisa Schwartz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154496453 PECOS PAC ID: 3072053453 Enrollment ID: I20240912000505 |
| Provider Name | Karen Alicia Larkin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295246064 PECOS PAC ID: 6103357165 Enrollment ID: I20241001002374 |
| Provider Name | Ilana Wexler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811631260 PECOS PAC ID: 7113458530 Enrollment ID: I20241009000853 |
| Provider Name | Gabrielle Josephine Hassan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487433496 PECOS PAC ID: 1456883610 Enrollment ID: I20241014002689 |
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