Healthcare Provider Details

I. General information

NPI: 1831450881
Provider Name (Legal Business Name): OASIS MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10418 220TH ST
QUEENS VILLAGE NY
11429-2145
US

IV. Provider business mailing address

4213 CHURCH AVE
BROOKLYN NY
11203-3011
US

V. Phone/Fax

Practice location:
  • Phone: 917-204-9723
  • Fax:
Mailing address:
  • Phone: 718-287-0868
  • Fax: 718-287-1375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number245310
License Number StateNY

VIII. Authorized Official

Name: DR. JEAN HEROLD ANCION
Title or Position: OWNER
Credential: MD
Phone: 917-204-9723