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1326265885 NPI number — EXECUTIVE MEDICAL CARE,P.C.

NPI Number: 1326265885
Health Care Provider/Practitioner: EXECUTIVE MEDICAL CARE,P.C.

Information about “1326265885” NPI (EXECUTIVE MEDICAL CARE,P.C.) exists in 1326265885 in HTML format HTML  |  1326265885 in plain Text format TXT  |  1326265885 in PDF (Portable Document Format) PDF  |  1326265885 in an XML format XML  formats.

NPI Number : 1326265885 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1326265885",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "EXECUTIVE MEDICAL CARE,P.C.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "42 GOODALL ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STATEN ISLAND",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10308-3396",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "646-270-8647",
    "MailingAddressFaxNumber": "718-891-7542",
    "FirstLinePracticeLocationAddress": "3049 BRIGHTON 6TH STREET",
    "SecondLinePracticeLocationAddress": "UNIT CU 1",
    "PracticeLocationAddressCityName": "BROOKLYN",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11235-6409",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "718-934-0322",
    "PracticeLocationAddressFaxNumber": "718-934-0994",
    "EnumerationDate": "04/19/2007",
    "LastUpdateDate": "07/26/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LUGINA",
    "AuthorizedOfficialFirstName": "SERGEY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT , MEDICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "D.O.",
    "AuthorizedOfficialTelephoneNumber": "646-270-8647",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "222476",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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