MEDICARE: ADVANCED MEDICAL CARE PLLC

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	207R00000X	Internal Medicine Physician
2	2084N0400X	Neurology Physician
3	363AM0700X	Medical Physician Assistant	009605	NY
4	207UN0901X	Nuclear Cardiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689745424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL CARE PLLC

Provider Business Mailing Address
First Line	:	10124 QUEENS BLVD STE A
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2703
Country	:	US
Telephone Number	:	718-261-8881
Fax Number	:	718-261-8889

Provider Business Practice Location Address
First Line	:	10124 QUEENS BLVD STE A
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2703
Country	:	US
Telephone Number	:	718-261-8881
Fax Number	:	718-261-8889

Authorized Official
Title or Position	:	MANAGER
Name	:	MELISSA GIBSON
Credential	:
Telephone Number	:	718-261-8068

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	05/03/2010

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Directions to “ADVANCED MEDICAL CARE PLLC ” Practice Location

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