Provider Demographics
NPI:1730399163
Name:PREMIUM MEDICAL CARE, P.C.
Entity type:Organization
Organization Name:PREMIUM MEDICAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-961-8881
Mailing Address - Street 1:6 PEPPERMILL RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3106
Mailing Address - Country:US
Mailing Address - Phone:212-470-1500
Mailing Address - Fax:718-961-4333
Practice Address - Street 1:13203 SANFORD AVE
Practice Address - Street 2:UNIT 1C, 1D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4309
Practice Address - Country:US
Practice Address - Phone:212-470-1500
Practice Address - Fax:718-961-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224337208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01717826Medicaid
NY02266255Medicaid