Provider Demographics
NPI:1215260427
Name:UNIVERSAL MEDICAL CARE
Entity type:Organization
Organization Name:UNIVERSAL MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-800-1416
Mailing Address - Street 1:883 SCHYULER AVE, # 23
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-4236
Mailing Address - Country:US
Mailing Address - Phone:201-800-1416
Mailing Address - Fax:
Practice Address - Street 1:883 SCHYULER AVE, # 23
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-4236
Practice Address - Country:US
Practice Address - Phone:201-800-1416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY600978261QU0200X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03026991Medicaid