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General NPI Number Information
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NPI Number | 1326265885
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Entity Type | Organization
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Legal Business Name | EXECUTIVE MEDICAL CARE,P.C.
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 3049 BRIGHTON 6TH STREET UNIT CU 1
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City | BROOKLYN
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State | NY
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Zip | 11235-6409
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Country | US
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Telephone | 718-934-0322
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Fax | 718-934-0994
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Provider Business Mailing Address
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Address Line | 42 GOODALL ST
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City | STATEN ISLAND
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State | NY
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Zip | 10308-3396
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Country | US
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Telephone | 646-270-8647
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Fax | 718-891-7542
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Authorized Official
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Title or Position | PRESIDENT , MEDICAL DIRECTOR
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Name | DR. SERGEY LUGINA
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Credential | D.O.
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Telephone | 646-270-8647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 222476
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License Number State | NY
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