NPIMap

Organization Active NPI

Main St. Med Care PC

  • Family Medicine Physician
  • Patchogue, NY
National Provider Identifier
1407889389
Registry record updated Mar 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MAIN ST. MED CARE PC
Practice address
475 E Main St
Suite 103-105
Patchogue, NY 11772-3121
Phone
(631) 447-6100
Fax
(631) 447-6126
NPI assigned
Jul 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2008

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

Authorized official

Name
Kristen Laird
Title
Administrator
Phone
(631) 447-6100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

475 E Main St
Suite 103-105
Patchogue, NY 11772-3121

Mailing address

475 E Main St
Suite 103-105
Patchogue, NY 11772-3121
Phone (631) 447-6100

National Provider Directory

National Provider Directory

Locations

475 E Main St
Ste 105
Patchogue, NY 11772
Phone (631) 447-6100

475 E Main St
Ste 103105
Patchogue, NY 11772
Phone (631) 289-0044

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205366400000",
    "number": "1407889389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 E MAIN ST",
            "address_2": "SUITE 103-105",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117723121",
            "telephone_number": "631-447-6100",
            "fax_number": "631-447-6126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 E MAIN ST",
            "address_2": "SUITE 103-105",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117723121",
            "telephone_number": "631-447-6100",
            "fax_number": "631-447-6126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN ST. MED CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2008-03-13",
        "status": "A",
        "authorized_official_last_name": "LAIRD",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "631-447-6100"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Patchogue, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; 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.