=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023299211
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED PRIMARY CARE ASSOCIATES LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2007
-----------------------------------------------------
Last Update Date | 09/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 265 POST AVE STE 114
-----------------------------------------------------
City | WESTBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11590-2233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-542-1180
-----------------------------------------------------
Fax | 516-832-4423
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 383
-----------------------------------------------------
City | WESTBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11590-0383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-542-1180
-----------------------------------------------------
Fax | 516-832-4423
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. ARSENIA RIVERA-MANZI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 516-542-1180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 163064
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------