| Kings Park Primary Medical Care Pc | |
|
65 Indian Head Rd Suite 2 Kings Park NY 11754-3729 | |
| (631) 269-0180 | |
| (631) 269-0178 |
| Full Name | Kings Park Primary Medical Care Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 65 Indian Head Rd, Kings Park, New York |
| Authorized Official Name and Position | Debra Pincus (PRESIDENT) |
| Authorized Official Contact | 6312690180 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kings Park Primary Medical Care Pc 65 Indian Head Rd Suite 2 Kings Park NY 11754-3729 Ph: (631) 269-0180 | Kings Park Primary Medical Care Pc 65 Indian Head Rd Suite 2 Kings Park NY 11754-3729 Ph: (631) 269-0180 |
| NPI Number | 1073747689 |
|---|---|
| Provider Enumeration Date | 05/11/2009 |
| Last Update Date | 05/11/2009 |
| Medicare PECOS PAC ID | 8921157561 |
|---|---|
| Medicare Enrollment ID | O20090601000262 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073747689 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 183029 (New York) | Primary |
| 208000000X | Pediatrics | 183029 (New York) | Secondary |
| Provider Name | Debra Pincus |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548255102 PECOS PAC ID: 7416006044 Enrollment ID: I20090601000214 |
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