Provider Demographics
NPI:1902903800
Name:WOMACK PRIMARY MEDICAL CARE, PLLC
Entity Type:Organization
Organization Name:WOMACK PRIMARY MEDICAL CARE, PLLC
Other - Org Name:WOMACK INTERNAL MEDICINE, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-277-0051
Mailing Address - Street 1:26 RAILROAD AVE # 205
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2204
Mailing Address - Country:US
Mailing Address - Phone:631-277-0051
Mailing Address - Fax:631-277-2690
Practice Address - Street 1:400 MONTAUK HWY
Practice Address - Street 2:STE 111
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4429
Practice Address - Country:US
Practice Address - Phone:631-277-0051
Practice Address - Fax:631-277-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3298766OtherAETNA/US HEALTHCARE
NY153114OtherVYTRA HEALTHCARE
NY02214588Medicaid
NYP00165433OtherRAILROAD MEDICARE
NYP2912790OtherOXFORD HEALTH PLAN
NY3298766OtherAETNA/US HEALTHCARE
NY02214588Medicaid
NYWMW011Medicare PIN
NYP00165433OtherRAILROAD MEDICARE