| Skope Medical Care P.c. | |
|
1537 Straight Path Ste 102 Wyandanch NY 11798-3414 | |
| (631) 253-0270 | |
| Not Available |
| Full Name | Skope Medical Care P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1537 Straight Path, Wyandanch, New York |
| Authorized Official Name and Position | Data Longjohn (PRESIDENT) |
| Authorized Official Contact | 6312530270 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Skope Medical Care P.c. 1537 Straight Path Ste 102 Wyandanch NY 11798-3414 Ph: (631) 253-0270 | Skope Medical Care P.c. 1537 Straight Path Ste 102 Wyandanch NY 11798-3414 Ph: (631) 253-0270 |
| NPI Number | 1356420715 |
|---|---|
| Provider Enumeration Date | 11/04/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2062498975 |
|---|---|
| Medicare Enrollment ID | O20040706000806 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356420715 | NPI | - | NPPES |
| 01889129 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 211159 (New York) | Primary |
| Provider Name | Data G Longjohn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215075882 PECOS PAC ID: 4082503479 Enrollment ID: I20040312001315 |
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