MEDICARE: PMCA LLC

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1528609138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PMCA LLC

Provider Business Mailing Address
First Line	:	2962 AVENUE X STE 1B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1808
Country	:	US
Telephone Number	:	718-717-5421
Fax Number	:	718-554-7788

Provider Business Practice Location Address
First Line	:	2962 AVENUE X STE 1B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1808
Country	:	US
Telephone Number	:	718-717-5421
Fax Number	:	718-554-7788

Authorized Official
Title or Position	:	VP
Name	:	MR. OLEG KRAYETS
Credential	:
Telephone Number	:	718-717-5421

Provider Enumeration Date	:	10/04/2019
Last Update Date	:	10/04/2019

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Directions to “PMCA LLC ” Practice Location

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