Provider Demographics
NPI:1386960052
Name:ADVANCE PRIMARY SPECIALTY CARE
Entity type:Organization
Organization Name:ADVANCE PRIMARY SPECIALTY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIARAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-299-1091
Mailing Address - Street 1:1957 SOUTHERN BLVD
Mailing Address - Street 2:2ND FL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-1419
Mailing Address - Country:US
Mailing Address - Phone:718-299-1091
Mailing Address - Fax:718-299-1230
Practice Address - Street 1:1957 SOUTHERN BLVD
Practice Address - Street 2:2ND FL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-1419
Practice Address - Country:US
Practice Address - Phone:718-299-1091
Practice Address - Fax:718-299-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization