Provider Demographics
NPI:1851636351
Name:REMEDIAL PRIMARY MEDICAL CARE, PC
Entity type:Organization
Organization Name:REMEDIAL PRIMARY MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FATIMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-317-8337
Mailing Address - Street 1:61 WILLETS DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3915
Mailing Address - Country:US
Mailing Address - Phone:516-317-8337
Mailing Address - Fax:631-675-9301
Practice Address - Street 1:252 W OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4011
Practice Address - Country:US
Practice Address - Phone:516-317-8337
Practice Address - Fax:631-675-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty