Basic Information
| Provider Information | |||||||||
| NPI: | 1053461665 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LONG ISLAND FAMILY MEDICAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WALK IN MEDICAL CARE PC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 765 ROUTE 25A | ||||||||
| Address2: | |||||||||
| City: | MILLER PLACE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117642649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315894747 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 765 ROUTE 25A | ||||||||
| Address2: | |||||||||
| City: | MILLER PLACE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117642649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315894747 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SIMAT | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6315898324 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.