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General NPI Number Information
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NPI Number | 1801238845
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Entity Type | Organization
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Legal Business Name | PREMIER CARE MEDICAL OF WEST ISLIP, PLLC
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Dates
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Enumeration Date | 07/18/2013
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | 292 HERRICKS RD
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City | MINEOLA
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State | NY
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Zip | 11501-1119
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Country | US
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Telephone | 516-292-8910
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Fax | 516-292-4009
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Provider Business Mailing Address
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Address Line | 2459 MERRICK RD
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City | BELLMORE
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State | NY
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Zip | 11710-5703
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Country | US
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Telephone | 516-783-4600
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Fax | 516-783-4612
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | DR. DAVID KIM
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Credential | MD
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Telephone | 516-783-4600
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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 |
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License Number State |
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