MEDICARE: DOUBLE CARE MEDICAL, 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	261QH0100X	Health Service Clinic/Center	213232	NY
2	261QH0100X	Health Service Clinic/Center	210590	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080404000114	OTHER	NY	FIDELIS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3029589	OTHER	NY	AETNA
4	41455P	OTHER	NY	HIP USA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	5996988	OTHER	NY	GHI
7	5998925	OTHER	NY	GHI
8	P2513676	OTHER	NY	OXFORD
9	P1834354	OTHER	NY	OXFORD
10	2188529	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1871727834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUBLE CARE MEDICAL, P.C.

Provider Business Mailing Address
First Line	:	400 FORT WASHINGTON AVE
Second Line	:	SUITE 1A
City	:	NEW YORK
State	:	NY
Zip	:	10033-6849
Country	:	US
Telephone Number	:	212-795-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 FORT WASHINGTON AVE
Second Line	:	SUITE 1A
City	:	NEW YORK
State	:	NY
Zip	:	10033-6849
Country	:	US
Telephone Number	:	212-795-9500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VLADIMIR MOLIVER
Credential	:	M.D., D.O.
Telephone Number	:	212-795-9500

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	10/05/2009

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