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General NPI Number Information
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NPI Number | 1285009464
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Entity Type | Organization
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Legal Business Name | EPIC MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 145 ORINOCO DR SUITE 614
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City | BRIGHTWATERS
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State | NY
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Zip | 11718-3024
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Country | US
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Telephone | 631-526-9305
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Fax | 631-526-9306
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Provider Business Mailing Address
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Address Line | PO BOX 614
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City | BRIGHTWATERS
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State | NY
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Zip | 11718-0614
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Country | US
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Telephone | 631-526-9305
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Fax | 631-526-9306
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | CHARISE Y GUADARRAMA
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Credential | PA
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Telephone | 631-526-9305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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