Healthcare Provider Details

I. General information

NPI: 1487050134
Provider Name (Legal Business Name): CAREMED PRIMARY AND URGENT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E ROE BLVD
PATCHOGUE NY
11772-2631
US

IV. Provider business mailing address

1 E ROE BLVD
PATCHOGUE NY
11772-2631
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-3900
  • Fax: 631-475-5166
Mailing address:
  • Phone: 631-475-3900
  • Fax: 631-475-5166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number271435
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number271435
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number271435
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier04770283
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: JODI SILVER-SMITH
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 631-475-3900