Provider Demographics
NPI:1710356043
Name:MID NASSAU MEDICAL CARE FOR KIDZ, LLC
Entity type:Organization
Organization Name:MID NASSAU MEDICAL CARE FOR KIDZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-333-7272
Mailing Address - Street 1:530 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-4500
Mailing Address - Country:US
Mailing Address - Phone:516-333-7272
Mailing Address - Fax:516-333-2519
Practice Address - Street 1:530 OLD COUNTRY RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-4500
Practice Address - Country:US
Practice Address - Phone:516-333-7272
Practice Address - Fax:516-333-2519
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID NASSAU MEDICAL CARE FOR KID
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0218647Medicaid
NY8307806Medicaid