Provider Demographics
NPI:1871727834
Name:DOUBLE CARE MEDICAL, P.C.
Entity type:Organization
Organization Name:DOUBLE CARE MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:212-795-9500
Mailing Address - Street 1:400 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6849
Mailing Address - Country:US
Mailing Address - Phone:212-795-9500
Mailing Address - Fax:
Practice Address - Street 1:400 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6849
Practice Address - Country:US
Practice Address - Phone:212-795-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210590261QH0100X
NY213232261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080404000114OtherFIDELIS
NY02065158Medicaid
NY3029589OtherAETNA
NY41455POtherHIP USA
NY01952661Medicaid
NY5996988OtherGHI
NY5998925OtherGHI
NYP2513676OtherOXFORD
NYP1834354OtherOXFORD
NY2188529OtherAETNA
NY01952661Medicaid
NY5998925OtherGHI
NYH12787Medicare UPIN
NY06V551Medicare PIN