| Sss Family Medicine Pc | |
|
11513a Merrick Blvd Jamaica NY 11434-1851 | |
| (718) 558-8998 | |
| (718) 558-8999 |
| Full Name | Sss Family Medicine Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11513a Merrick Blvd, Jamaica, New York |
| Authorized Official Name and Position | Sophia Streete-smalls (PRESIDENT) |
| Authorized Official Contact | 9176936687 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sss Family Medicine Pc 11513a Merrick Blvd Jamaica NY 11434-1851 Ph: (718) 558-8998 | Sss Family Medicine Pc 11513a Merrick Blvd Jamaica NY 11434-1851 Ph: (718) 558-8998 |
| NPI Number | 1588987234 |
|---|---|
| Provider Enumeration Date | 03/10/2010 |
| Last Update Date | 03/10/2010 |
| Medicare PECOS PAC ID | 3476684796 |
|---|---|
| Medicare Enrollment ID | O20100701000154 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588987234 | NPI | - | NPPES |
| 02180096 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 218731 (New York) | Primary |
| Provider Name | Sophia Streete-smalls |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033298906 PECOS PAC ID: 5496779720 Enrollment ID: I20100701000198 |
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