Basic Information
| Provider Information | |||||||||
| NPI: | 1801238845 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER CARE MEDICAL OF WEST ISLIP, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2459 MERRICK RD | ||||||||
| Address2: | |||||||||
| City: | BELLMORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117105703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167834600 | ||||||||
| FaxNumber: | 5167834612 | ||||||||
| Practice Location | |||||||||
| Address1: | 292 HERRICKS RD | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115011119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162928910 | ||||||||
| FaxNumber: | 5162924009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2013 | ||||||||
| LastUpdateDate: | 07/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | KIM | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5167834600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.