Provider Demographics
NPI:1871871483
Name:FIRST PREMIER CARE MEDICAL, P.C.
Entity type:Organization
Organization Name:FIRST PREMIER CARE MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:ACEBO
Authorized Official - Last Name:CUBANGBANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-929-8589
Mailing Address - Street 1:894 OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1936
Mailing Address - Country:US
Mailing Address - Phone:917-929-8589
Mailing Address - Fax:516-270-2755
Practice Address - Street 1:20607 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1709
Practice Address - Country:US
Practice Address - Phone:917-929-8589
Practice Address - Fax:516-270-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-30
Last Update Date:2011-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090193208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty