Healthcare Provider Details

I. General information

NPI: 1588675466
Provider Name (Legal Business Name): ISLAND URGENT MEDICAL CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 EAST MAIN ST SUITE C
RIVERHEAD NY
11901
US

IV. Provider business mailing address

1228 EAST MAIN ST SUITE C
RIVERHEAD NY
11901
US

V. Phone/Fax

Practice location:
  • Phone: 631-603-3400
  • Fax: 631-603-3401
Mailing address:
  • Phone: 631-603-3400
  • Fax: 631-603-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNY215053
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number170935
License Number StateNY

VIII. Authorized Official

Name: DR. DANIEL R FERRARA
Title or Position: PRESIDENT
Credential: DO
Phone: 631-514-7606