Promedex. Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PROMEDEX. INC

Doing business as

Procare

Practice address

136-71 41Ave
Flushing, NY 11355-2433

Phone

(718) 939-4008

Fax

(718) 939-5508

NPI assigned

Dec 26, 2006

Last updated

Jul 21, 2022By 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

Mr. Jong Ku Park

Title

President

Phone

(718) 939-4008

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Procare Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1922163468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136-71 41AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113552433",
            "telephone_number": "718-939-4008",
            "fax_number": "718-939-5508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136-71 41AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113552433",
            "telephone_number": "718-939-4008",
            "fax_number": "718-939-5508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDEX. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JONG",
        "authorized_official_middle_name": "KU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-939-4008",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NU",
            "license": "C0002130",
            "primary": false
        },
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": "NU",
            "license": "C49901",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02709800",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Procare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Flushing, NY
• Providers in Flushing, NY by specialty
• Durable Medical Equipment & Medical Supplies in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.