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General NPI Number Information
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NPI Number | 1053465351
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Entity Type | Organization
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Legal Business Name | IMMEDIATE CARE EAST WALK-IN MEDICAL TREATMENT, PLLC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1600 MOSELEY RD
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City | VICTOR
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State | NY
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Zip | 14564-9738
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Country | US
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Telephone | 585-582-1202
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 MOSELEY RD
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City | VICTOR
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State | NY
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Zip | 14564-9738
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Country | US
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Telephone | 585-582-1202
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAUREEN D. MCRAE
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Credential | MD
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Telephone | 585-582-1201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 211789
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License Number State | NY
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