Life Care Medical Ny PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

LIFE CARE MEDICAL NY PC

Practice address

170 Old Country Rd
Riverhead, NY 11901-2198

Phone

(631) 208-4460

Fax

(631) 208-4462

NPI assigned

Aug 21, 2023

Organization subpart

No

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

Authorized official

Name

Simon Fensterszaub, DO

Title

President

Phone

(631) 208-4460

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1692576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1821872144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 OLD COUNTRY RD",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012198",
            "telephone_number": "631-208-4460",
            "fax_number": "631-208-4462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 OLD COUNTRY RD",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012198",
            "telephone_number": "631-208-4460",
            "fax_number": "631-208-4462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CARE MEDICAL NY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-21",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-20",
        "status": "A",
        "authorized_official_last_name": "FENSTERSZAUB",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-208-4460",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Riverhead, NY
• Providers in Riverhead, 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 Aug 21, 2023; 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.