Provider Demographics
NPI:1104270198
Name:NASSAU MEDICAL HOME VISITS P.C.
Entity type:Organization
Organization Name:NASSAU MEDICAL HOME VISITS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRIGORIY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRICHMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-271-9151
Mailing Address - Street 1:60 QUEENS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 QUEENS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3058
Practice Address - Country:US
Practice Address - Phone:631-271-9151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-16
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty