Prime Care on the Bay LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

7001106R Issued in NY

Legal business name

PRIME CARE ON THE BAY LLC

Practice address

1711 Sheepshead Bay Rd
Ground Floor
Brooklyn, NY 11235-3651

Phone

(718) 332-8002

Fax

(718) 332-8006

NPI assigned

Oct 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Eldar Kadymoff, D.O.

Title

Medical Director

Phone

(718) 332-8002

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193788800000",
    "number": "1023297694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 SHEEPSHEAD BAY RD",
            "address_2": "GROUND FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112353651",
            "telephone_number": "718-332-8002",
            "fax_number": "718-332-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 SHEEPSHEAD BAY RD",
            "address_2": "GROUND FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112353651",
            "telephone_number": "718-332-8002",
            "fax_number": "718-332-8006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME CARE ON THE BAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-30",
        "last_updated": "2007-10-31",
        "status": "A",
        "authorized_official_last_name": "KADYMOFF",
        "authorized_official_first_name": "ELDAR",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "718-332-8002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "7001106R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02426653",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Primax Medical PC
• Prime Care Drug & Surgicals Corp
• Prime Care Drug & Surgicals Corp
• Prime Care Drug & Surgicals Corp.
• Prime Care Medical of Brighton PC
• Prime Care Supply Inc
• Prime Dental Care PC
• Prime Developmental Services
• Prime Fitness Physical Therapy PC
• Prime Health Pharmacy LLC

• Primary Care Clinic/Center in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Primary Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.