Provider Demographics
NPI:1154548329
Name:A&M ADVANCED MEDICAL CARE PC
Entity type:Organization
Organization Name:A&M ADVANCED MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-743-7090
Mailing Address - Street 1:75 OCEANA DR E
Mailing Address - Street 2:PENTHOUSE 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6668
Mailing Address - Country:US
Mailing Address - Phone:718-743-6124
Mailing Address - Fax:
Practice Address - Street 1:6260 108TH ST
Practice Address - Street 2:SUITE 1J
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1356
Practice Address - Country:US
Practice Address - Phone:718-275-2224
Practice Address - Fax:718-275-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02554805Medicaid
NYI03378Medicare UPIN
NY02554805Medicaid