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General NPI Number Information
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NPI Number | 1588675466
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Entity Type | Organization
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Legal Business Name | ISLAND URGENT MEDICAL CARE, P.C.
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 08/12/2009
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Provider Practice Location Address
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Address Line | 1228 EAST MAIN ST SUITE C
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City | RIVERHEAD
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State | NY
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Zip | 11901
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Country | US
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Telephone | 631-603-3400
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Fax | 631-603-3401
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Provider Business Mailing Address
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Address Line | 1228 EAST MAIN ST SUITE C
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City | RIVERHEAD
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State | NY
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Zip | 11901
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Country | US
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Telephone | 631-603-3400
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Fax | 631-603-3401
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL R FERRARA
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Credential | DO
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Telephone | 631-514-7606
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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 | NY215053
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 170935
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License Number State | NY
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