Healthcare Provider Details

I. General information

NPI: 1154813137
Provider Name (Legal Business Name): ACTIVE MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N MIDDLETOWN RD STE 1F
PEARL RIVER NY
10965
US

IV. Provider business mailing address

275 N MIDDLETOWN RD STE 1F
PEARL RIVER NY
10965-1189
US

V. Phone/Fax

Practice location:
  • Phone: 914-376-6100
  • Fax: 914-231-6872
Mailing address:
  • Phone: 914-376-6100
  • Fax: 914-231-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EDNAN S SHEIK
Title or Position: OWNER
Credential: MD
Phone: 215-593-5484