Provider Demographics
NPI:1720170400
Name:HICKSVILLE MEDICAL CARE, PC
Entity type:Organization
Organization Name:HICKSVILLE MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAUSER
Authorized Official - Middle Name:
Authorized Official - Last Name:YASMEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-942-5800
Mailing Address - Street 1:117 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3908
Mailing Address - Country:US
Mailing Address - Phone:516-942-5800
Mailing Address - Fax:516-298-8786
Practice Address - Street 1:117 NEWBRIDGE RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3908
Practice Address - Country:US
Practice Address - Phone:516-942-5800
Practice Address - Fax:516-298-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWDM851Medicare PIN