Healthcare Provider Details

I. General information

NPI: 1417736109
Provider Name (Legal Business Name): OPTUM MEDICAL CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 HEMPSTEAD TPKE
BETHPAGE NY
11714-5611
US

IV. Provider business mailing address

PO BOX 95000
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 516-396-1027
  • Fax: 516-396-1019
Mailing address:
  • Phone: 914-241-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN F NASSER
Title or Position: CEO
Credential: MD
Phone: 845-703-6999