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1 Wagner Ave Roosevelt NY 11575-1528 | |
(516) 571-8600 | |
(516) 546-4154 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1 Wagner Ave, Roosevelt, New York |
Authorized Official Name and Position | David Aaron Nemiroff (CEO, PRESIDENT) |
Authorized Official Contact | 5162964198 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1600 Stewart Ave Ste 300 Westbury NY 11590-6611 Ph: (516) 396-0187 | 1 Wagner Ave Roosevelt NY 11575-1528 Ph: (516) 571-8600 |
NPI Number | 1437889029 |
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Provider Enumeration Date | 06/15/2022 |
Last Update Date | 02/14/2024 |
Medicare PECOS PAC ID | 5991970535 |
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Medicare Enrollment ID | O20230411000712 |
Identifier | Type | State | Issuer |
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1437889029 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Secondary |