Organization
HICKSVILLE PRIMARY MEDICAL CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANKUR PATEL (CREDENTIALING COORDINATOR)
(908) 966-7395
Entity
Organization
Contact information
Practice address
380 S BROADWAY, HICKSVILLE, NY 11801-5033
(516) 937-7600
(718) 343-7603
Mailing address
380 S BROADWAY, HICKSVILLE, NY 11801-5033
(516) 937-7600
(718) 343-7603
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225462
LICENSE
NY
Enumeration date
02/21/2019
Last updated
02/21/2019
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