Basic Information
| Provider Information | |||||||||
| NPI: | 1770531220 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIME CARE MEDICAL OF LONG ISLAND, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 W MONTAUK HWY | ||||||||
| Address2: | |||||||||
| City: | HAMPTON BAYS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119463510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317284500 | ||||||||
| FaxNumber: | 6317284564 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 W MONTAUK HWY | ||||||||
| Address2: | |||||||||
| City: | HAMPTON BAYS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119463510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317284500 | ||||||||
| FaxNumber: | 6317284564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROSENSTREICH | ||||||||
| AuthorizedOfficialFirstName: | SAUL | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6315486470 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.