MEDICARE: EXCEL URGENT CARE OF EAST NORTHPORT, PLLC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DU2258	OTHER		RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1881978021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL URGENT CARE OF EAST NORTHPORT, PLLC

Provider Business Mailing Address
First Line	:	484 TEMPLE HILL RD STE 104
Second Line	:
City	:	NEW WINDSOR
State	:	NY
Zip	:	12553-5529
Country	:	US
Telephone Number	:	845-565-3700
Fax Number	:	845-565-3696

Provider Business Practice Location Address
First Line	:	558 LARKFIELD RD
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-4204
Country	:	US
Telephone Number	:	631-486-7459
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED MEMBER
Name	:	ANTHONY R RUVO
Credential	:	MD
Telephone Number	:	845-565-3700

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	10/26/2017

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