Healthcare Provider Details

I. General information

NPI: 1497925291
Provider Name (Legal Business Name): MED-ONE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TALON WAY
DIX HILLS NY
11746-6239
US

IV. Provider business mailing address

217-14 MERRICK BOULEVARD
LAUELTON NY
11413
US

V. Phone/Fax

Practice location:
  • Phone: 914-217-6309
  • Fax:
Mailing address:
  • Phone: 914-217-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number177073
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number177073
License Number StateNY

VIII. Authorized Official

Name: DR. SAMUEL I OKONTA
Title or Position: CEO/ MEDICAL DIRECTOR
Credential: M D
Phone: 914-217-6309