Kings Park Primary Medical Care PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

183029 Issued in NY

Legal business name

KINGS PARK PRIMARY MEDICAL CARE PC

Practice address

65 Indian Head Rd
Suite 2
Kings Park, NY 11754-3729

Phone

(631) 269-0180

Fax

(631) 269-0178

NPI assigned

May 11, 2009

Last updated

May 11, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Debra PincusNPI 1548255102

Title

President

Phone

(631) 269-0180

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Debra Pincus, MD

  • Internal Medicine Physician
  • Kings Park, NY
  • NPI 1548255102
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1242000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242000000000",
    "number": "1073747689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 INDIAN HEAD RD",
            "address_2": "SUITE 2",
            "city": "KINGS PARK",
            "state": "NY",
            "postal_code": "117543729",
            "telephone_number": "631-269-0180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 INDIAN HEAD RD",
            "address_2": "SUITE 2",
            "city": "KINGS PARK",
            "state": "NY",
            "postal_code": "117543729",
            "telephone_number": "631-269-0180",
            "fax_number": "631-269-0178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGS PARK PRIMARY MEDICAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-11",
        "last_updated": "2009-05-11",
        "status": "A",
        "authorized_official_last_name": "PINCUS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-269-0180",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "183029",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "183029",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kings Park Central School District
• Kings Park Fire Dist
• Kings Park Medicine PC
• Kings Park Physical Therapy PC
• Kings Park Podiatry PLLC
• Sabrina Angela Klemballa
• Tonianne Klis
• Claire Diane Kolensky, M.D.
• Stacie Lee Kolker, LCSW
• Deirdre Kozyrski

• Internal Medicine Physician in Kings Park, NY
• Providers in Kings Park, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.