Healthcare Provider Details

I. General information

NPI: 1043452816
Provider Name (Legal Business Name): UNITED CARE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 BAY ST
STATEN ISLAND NY
10304-3830
US

IV. Provider business mailing address

690 BAY ST
STATEN ISLAND NY
10304-3830
US

V. Phone/Fax

Practice location:
  • Phone: 718-815-7050
  • Fax:
Mailing address:
  • Phone: 718-815-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number247604
License Number StateNY

VIII. Authorized Official

Name: DR. SERGE MENKIN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-815-7050