Healthcare Provider Details

I. General information

NPI: 1023784618
Provider Name (Legal Business Name): TRIAGE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 62ND ST
BROOKLYN NY
11220-4112
US

IV. Provider business mailing address

679 62ND ST
BROOKLYN NY
11220-4112
US

V. Phone/Fax

Practice location:
  • Phone: 917-682-1932
  • Fax:
Mailing address:
  • Phone: 917-682-1932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. SIMON DUONG
Title or Position: PHYSICIAN ASSISTANT
Credential: RPA-C
Phone: 917-682-1932