| Innovative Medical Care Pllc | |
|
375 Commack Rd Unit A Deer Park NY 11729-5522 | |
| (631) 940-1834 | |
| (631) 940-1834 |
| Full Name | Innovative Medical Care Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 375 Commack Rd Unit A, Deer Park, New York |
| Authorized Official Name and Position | Behrouz Farahmandpour (PRESIDENT) |
| Authorized Official Contact | 6319400409 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Medical Care Pllc 375 Commack Rd Unit A Deer Park NY 11729-5522 Ph: (631) 940-1834 | Innovative Medical Care Pllc 375 Commack Rd Unit A Deer Park NY 11729-5522 Ph: (631) 940-1834 |
| NPI Number | 1063720910 |
|---|---|
| Provider Enumeration Date | 09/14/2010 |
| Last Update Date | 03/30/2025 |
| Medicare PECOS PAC ID | 4688863467 |
|---|---|
| Medicare Enrollment ID | O20110110000418 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063720910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 233446 (New York) | Primary |
| Provider Name | Behrouz Farahmandpour |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447246756 PECOS PAC ID: 4981634516 Enrollment ID: I20050815000132 |
| Provider Name | Brian Gerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740552637 PECOS PAC ID: 7214358977 Enrollment ID: I20200604001401 |
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