Healthcare Provider Details

I. General information

NPI: 1861486268
Provider Name (Legal Business Name): PRIME CARE MEDICAL SUPPLIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CORPORATE DRIVE
HOLTSVILLE NY
11742
US

IV. Provider business mailing address

25 CORPORATE DRIVE
HOLTSVILLE NY
11742
US

V. Phone/Fax

Practice location:
  • Phone: 631-447-0093
  • Fax: 631-447-0148
Mailing address:
  • Phone: 631-447-0093
  • Fax: 631-447-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNY

VIII. Authorized Official

Name: PETER AMICO
Title or Position: PRESIDENT
Credential:
Phone: 631-447-0093