Provider Demographics
NPI:1396175170
Name:STAT HEALTH IMMEDIATE MEDICAL CARE, PC
Entity type:Organization
Organization Name:STAT HEALTH IMMEDIATE MEDICAL CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:R
Authorized Official - Last Name:SALZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-360-5900
Mailing Address - Street 1:519 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2619
Mailing Address - Country:US
Mailing Address - Phone:631-360-5900
Mailing Address - Fax:631-360-9403
Practice Address - Street 1:519 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2619
Practice Address - Country:US
Practice Address - Phone:631-360-5900
Practice Address - Fax:631-360-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWAW171OtherSTAT HEALTH ID#