Healthcare Provider Details

I. General information

NPI: 1740264332
Provider Name (Legal Business Name): HEALTHCARE ASSOCIATES IN MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 TARGEE ST HEALTHCARE ASSOCIATES IN MEDICINE PC
STATEN ISLAND NY
10304-4310
US

IV. Provider business mailing address

1099 TARGEE ST HEALTHCARE ASSOCIATES IN MEDICINE PC
STATEN ISLAND NY
10304-4310
US

V. Phone/Fax

Practice location:
  • Phone: 718-448-3210
  • Fax: 718-720-1271
Mailing address:
  • Phone: 718-448-3210
  • Fax: 718-442-9085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL I BERKLEY
Title or Position: ADMINISTRATOR
Credential: CMPE
Phone: 718-448-3210