Healthcare Provider Details

I. General information

NPI: 1073069670
Provider Name (Legal Business Name): PRECISION CARE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2781 SHELL RD STE 101
BROOKLYN NY
11223-6142
US

IV. Provider business mailing address

2781 SHELL RD STE 101
BROOKLYN NY
11223-6142
US

V. Phone/Fax

Practice location:
  • Phone: 718-648-1234
  • Fax: 718-648-1239
Mailing address:
  • Phone: 718-648-1234
  • Fax: 718-648-1239

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 Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: VADIM ZARUBIN
Title or Position: MD
Credential:
Phone: 718-648-1234