Healthcare Provider Details

I. General information

NPI: 1235916255
Provider Name (Legal Business Name): SACRED HEART PRIMARY CARE MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 OLD COUNTRY RD STE 105
PLAINVIEW NY
11803-4932
US

IV. Provider business mailing address

700 OLD COUNTRY RD STE 105
PLAINVIEW NY
11803-4932
US

V. Phone/Fax

Practice location:
  • Phone: 347-510-5866
  • Fax:
Mailing address:
  • Phone: 516-809-2500
  • Fax: 833-450-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. DIMITRI GHECAS
Title or Position: CO-OWNER
Credential: PA-C
Phone: 516-809-2500