Healthcare Provider Details

I. General information

NPI: 1770531220
Provider Name (Legal Business Name): PRIME CARE MEDICAL OF LONG ISLAND, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W MONTAUK HWY
HAMPTON BAYS NY
11946-3510
US

IV. Provider business mailing address

240 W MONTAUK HWY
HAMPTON BAYS NY
11946-3510
US

V. Phone/Fax

Practice location:
  • Phone: 631-728-4500
  • Fax: 631-728-4564
Mailing address:
  • Phone: 631-728-4500
  • Fax: 631-728-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAUL J. ROSENSTREICH
Title or Position: PRESIDENT
Credential: MD
Phone: 631-548-6470