Provider Demographics
NPI:1346472495
Name:PROVIDER MEDICAL CARE PC
Entity type:Organization
Organization Name:PROVIDER MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-225-9059
Mailing Address - Street 1:7616 BAY PARKWAY 1 FLOOR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1516
Mailing Address - Country:US
Mailing Address - Phone:718-943-0100
Mailing Address - Fax:718-943-0101
Practice Address - Street 1:7616 BAY PARKWAY 1 FLOOR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1516
Practice Address - Country:US
Practice Address - Phone:516-225-9059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1374P1Medicare PIN
NYA100018004Medicare PIN
NYA400019045Medicare PIN
NYA400018005Medicare PIN