Healthcare Provider Details

I. General information

NPI: 1437981958
Provider Name (Legal Business Name): URGENT SURGICAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17561 HILLSIDE AVE STE 202
JAMAICA NY
11432-5771
US

IV. Provider business mailing address

17561 HILLSIDE AVE STE 202
JAMAICA NY
11432-5771
US

V. Phone/Fax

Practice location:
  • Phone: 929-279-3399
  • Fax:
Mailing address:
  • Phone: 929-279-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMLYN LONG
Title or Position: OWNER
Credential: MD
Phone: 929-279-3399