MEDICARE: NY PRIMARY CARE PRACTICE, 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1851890289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY PRIMARY CARE PRACTICE, PC

Provider Business Mailing Address
First Line	:	PO BOX 500
Second Line	:
City	:	ELLICOTTVILLE
State	:	NY
Zip	:	14731-0500
Country	:	US
Telephone Number	:	716-699-9032
Fax Number	:	716-699-9035

Provider Business Practice Location Address
First Line	:	446 FAIRVIEW AVE STE 200
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-1048
Country	:	US
Telephone Number	:	518-267-3496
Fax Number	:	518-237-3497

Authorized Official
Title or Position	:	DIRECTOR OF BILLING
Name	:	KIM M CARDINALE
Credential	:
Telephone Number	:	716-699-9032

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	02/12/2018

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