MEDICARE: OPTUM MEDICAL CARE, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1275312977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM MEDICAL CARE, P.C.

Provider Business Mailing Address
First Line	:	110 S BEDFORD RD
Second Line	:
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-3446
Country	:	US
Telephone Number	:	914-241-1050
Fax Number	:	914-242-1516

Provider Business Practice Location Address
First Line	:	575 UNDERHILL BLVD STE 190
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-3494
Country	:	US
Telephone Number	:	516-210-8840
Fax Number	:	516-210-8842

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD P MOREL
Credential	:	MD
Telephone Number	:	914-242-2940

Provider Enumeration Date	:	09/22/2023
Last Update Date	:	09/22/2023

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