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First Choice Medical PLLC

Organization Active NPI Internal Medicine Physician · Holbrook, NY

NPI 1043355159 · NPPES record last updated Nov 14, 2007

Key facts

NPI
1043355159
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
License
164959 (NY)
Legal business name
FIRST CHOICE MEDICAL PLLC
Practice address
203 Union Ave
Holbrook, NY 11741-1704
Phone
(631) 585-5858
Fax
(631) 585-6362
NPI assigned
Feb 20, 2007
Organization subpart
No

Authorized official

Name
Adeline Fontana
Title
Office Manager
Phone
(631) 585-5858

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040319000134 NY Part B Supplier - Clinic/Group Practice 1456241660 Receives reassigned benefits from 11 practitioners
Practice locations: Holbrook, NY

National Provider Directory

Locations

5 Eastport Manor Rd
Eastport, NY 11941
Phone (516) 325-2255

21 Eastport Manor Rd
Eastport, NY 11941
Phone (631) 325-2255

203 Union Ave
Holbrook, NY 11741
Phone (631) 585-5858

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 207R00000X 164959 NY Yes

Addresses

Primary practice location

203 Union Ave
Holbrook, NY 11741-1704

Mailing address

203 Union Ave
Holbrook, NY 11741-1704
Phone (631) 585-5858

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 14, 2007.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194998400000",
    "number": "1043355159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 UNION AVE",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117411704",
            "telephone_number": "631-585-5858",
            "fax_number": "631-585-6362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 UNION AVE",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117411704",
            "telephone_number": "631-585-5858",
            "fax_number": "631-585-6362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST CHOICE MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-11-14",
        "status": "A",
        "authorized_official_last_name": "FONTANA",
        "authorized_official_first_name": "ADELINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "631-585-5858"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "164959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holbrook, NY

All providers in Holbrook, NY · Internal Medicine Physician in New York

Sources for this page

Verify at the official NPI Registry.