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General NPI Number Information
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NPI Number | 1003963026
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Entity Type | Organization
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Legal Business Name | IMMEDIATE FAMILY CARE, LLC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 41 BRENTWOOD ROAD
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City | BAY SHORE
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State | NY
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Zip | 11706-6924
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Country | US
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Telephone | 631-968-0800
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Fax | 631-665-0816
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Provider Business Mailing Address
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Address Line | 41 BRENTWOOD ROAD
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City | BAY SHORE
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State | NY
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Zip | 11706-6924
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Country | US
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Telephone | 631-968-0800
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Fax | 631-665-0816
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES W FERGUSON
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Credential | MD
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Telephone | 631-968-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 150415
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License Number State | NY
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