Healthcare Provider Details

I. General information

NPI: 1366208639
Provider Name (Legal Business Name): 37 MAIN STREET MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 MERRICK AVE
MERRICK NY
11566-3147
US

IV. Provider business mailing address

2094 MERRICK AVE
MERRICK NY
11566-3147
US

V. Phone/Fax

Practice location:
  • Phone: 516-600-0676
  • Fax: 516-863-2963
Mailing address:
  • Phone: 516-600-0676
  • Fax: 718-709-4282

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KAMRAN SIDDIQUI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 516-600-0676