Healthcare Provider Details

I. General information

NPI: 1114172848
Provider Name (Legal Business Name): JPR URGENT MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 S BROADWAY
HICKSVILLE NY
11801-5009
US

IV. Provider business mailing address

412 S BROADWAY
HICKSVILLE NY
11801-5009
US

V. Phone/Fax

Practice location:
  • Phone: 516-938-1550
  • Fax: 516-938-1554
Mailing address:
  • Phone: 516-938-1550
  • Fax: 516-938-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number29023847
License Number StateNY

VIII. Authorized Official

Name: PRITI JAIN
Title or Position: PRESIDENT
Credential: MD
Phone: 516-938-1550