Healthcare Provider Details

I. General information

NPI: 1083698377
Provider Name (Legal Business Name): IMMEDIATE MEDICAL CARE ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 W GENESEE ST SUITE 100 SOUTH
CAMILLUS NY
13031-3200
US

IV. Provider business mailing address

5700 W GENESEE ST SUITE 100 SOUTH
CAMILLUS NY
13031-3200
US

V. Phone/Fax

Practice location:
  • Phone: 315-488-6393
  • Fax: 315-488-5854
Mailing address:
  • Phone: 315-488-6393
  • Fax: 315-488-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALAN MANCUSI-UNGARO
Title or Position: SENIOR PARTNER
Credential: M.D.
Phone: 315-488-6393