MEDICARE: JANICE PRIME CARE MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275752750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANICE PRIME CARE MEDICAL PC

Provider Business Mailing Address
First Line	:	14 KRISTI DRIVE
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753
Country	:	US
Telephone Number	:	516-708-7008
Fax Number	:	134-746-4085

Provider Business Practice Location Address
First Line	:	1530 BEDFORD AVE FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-4117
Country	:	US
Telephone Number	:	718-400-6951
Fax Number	:	347-789-9300

Authorized Official
Title or Position	:	PRESIDENT JANICE PRIME CARE MEDICAL
Name	:	MEENAL SHUKLA
Credential	:	MD
Telephone Number	:	516-708-7008

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	02/16/2022

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