| Life Care Medical Ny Pc | |
|
170 Old Country Rd Riverhead NY 11901-2198 | |
| (631) 208-4460 | |
| (631) 208-4462 |
| Full Name | Life Care Medical Ny Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 170 Old Country Rd, Riverhead, New York |
| Authorized Official Name and Position | Simon Fensterszaub (PRESIDENT) |
| Authorized Official Contact | 6312084460 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Care Medical Ny Pc 170 Old Country Rd Riverhead NY 11901-2198 Ph: (631) 208-4460 | Life Care Medical Ny Pc 170 Old Country Rd Riverhead NY 11901-2198 Ph: (631) 208-4460 |
| NPI Number | 1821872144 |
|---|---|
| Provider Enumeration Date | 08/21/2023 |
| Last Update Date | 08/21/2023 |
| Medicare PECOS PAC ID | 9032566336 |
|---|---|
| Medicare Enrollment ID | O20231108001239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821872144 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Simon Fensterszaub |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003077322 PECOS PAC ID: 5890970230 Enrollment ID: I20110428000025 |
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