Organization Active NPI

Highland Valley Medical Care PLLC

  • Family Medicine Physician
  • Coram, NY
National Provider Identifier
1831971449
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HIGHLAND VALLEY MEDICAL CARE PLLC
Doing business as
highland valley medical care pllc
Practice address
369 Middle Country Rd Ste 1
Coram, NY 11727-3734
Phone
(631) 413-4765
NPI assigned
Oct 18, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Authorized official

Name
Tina Malek, MANAGER
Title
Credentialing Contact
Phone
(631) 413-4765

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

369 Middle Country Rd Ste 1
Coram, NY 11727-3734

Mailing address

1797 Veterans Memorial Hwy Ste 1
Islandia, NY 11749-1537
Phone (631) 413-4765

Other names 1

  • highland valley medical care pllc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240612000853 NY Part B Supplier - Clinic/Group Practice 5890237358 Receives reassigned benefits from 4 practitioners
Practice locations: Coram, NY

National Provider Directory

National Provider Directory

Locations

369 Middle Country Rd
Ste 1
Coram, NY 11727
Phone (631) 413-4765

369 Middle Country Rd
Coram, NY 11727
Phone (631) 698-1967

1797 Veterans Memorial Hwy
Ste 1
Islandia, NY 11749

Practitioners & affiliated clinicians

Practitioners 4

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": "1697587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1831971449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1797 VETERANS MEMORIAL HWY STE 1",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117491537",
            "telephone_number": "631-413-4765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 MIDDLE COUNTRY RD STE 1",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117273734",
            "telephone_number": "631-413-4765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND VALLEY MEDICAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-18",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "MALEK",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "CREDENTIALING CONTACT",
        "authorized_official_telephone_number": "631-413-4765",
        "authorized_official_credential": "MANAGER"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "highland valley medical care pllc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coram, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.