Healthcare Provider Details

I. General information

NPI: 1285009464
Provider Name (Legal Business Name): EPIC MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 ORINOCO DR SUITE 614
BRIGHTWATERS NY
11718-3024
US

IV. Provider business mailing address

PO BOX 614
BRIGHTWATERS NY
11718-0614
US

V. Phone/Fax

Practice location:
  • Phone: 631-526-9305
  • Fax: 631-526-9306
Mailing address:
  • Phone: 631-526-9305
  • Fax: 631-526-9306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHARISE Y GUADARRAMA
Title or Position: PRESIDENT/OWNER
Credential: PA
Phone: 631-526-9305