Healthcare Provider Details

I. General information

NPI: 1982976999
Provider Name (Legal Business Name): EXPRESS MEDICAL CARE, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

.357 BROADWAY SUITE 2C
AMITYVILLE NY
11701
US

IV. Provider business mailing address

357 BROADWAY SUITE 2C
AMITYVILLE NY
11701-2748
US

V. Phone/Fax

Practice location:
  • Phone: 631-789-7900
  • Fax: 631-608-8492
Mailing address:
  • Phone: 631-789-7900
  • Fax: 631-608-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number204874
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number204874
License Number StateNY

VIII. Authorized Official

Name: LAMYA RIZK
Title or Position: ADMINSTRATOR
Credential:
Phone: 516-351-3331