1437449212 NPI number — TOTAL MEDICAL NY P.C.

Table of content: (NPI 1437449212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437449212 NPI number — TOTAL MEDICAL NY P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL MEDICAL NY P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437449212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1372 E 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11230-5104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9324 QUEENS BLVD
Provider Second Line Business Practice Location Address:
1G
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-730-9040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOLDBERG
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
347-729-8793

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  244295 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)