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General NPI Number Information
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NPI Number | 1851663926
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Entity Type | Organization
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Legal Business Name | PENINSULA MEDICAL CARE PLLC
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 115 - 06 BEACH CHANNEL DR SUITE 1
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2206
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Country | US
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Telephone | 718-954-2202
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Fax | 718-351-6848
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Provider Business Mailing Address
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Address Line | 11506 BEACH CHANNEL DR SUITE 1
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2206
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Country | US
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Telephone | 718-954-2202
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Fax | 718-351-6848
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SADHANA GUPTA
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Credential | MD
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Telephone | 718-954-2202
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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 | 214772
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License Number State | NY
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