Healthcare Provider Details

I. General information

NPI: 1245143288
Provider Name (Legal Business Name): LEGACY PRIME INSURANCE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 RESERVE CT
SAN MARCOS CA
92078-2054
US

IV. Provider business mailing address

237 RESERVE CT
SAN MARCOS CA
92078-2054
US

V. Phone/Fax

Practice location:
  • Phone: 914-904-6841
  • Fax: 877-777-0450
Mailing address:
  • Phone: 914-904-6841
  • Fax: 877-777-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. VIKALP KUMAR
Title or Position: CEO
Credential:
Phone: 914-904-6841