1538306352 NPI number — JUNCTION MEDICAL OFFICE, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538306352 NPI number — JUNCTION MEDICAL OFFICE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUNCTION MEDICAL OFFICE, 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:
1538306352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9211 35TH AVE
Provider Second Line Business Mailing Address:
SUITE 1E
Provider Business Mailing Address City Name:
JACKSON HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11372-5866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-429-4555
Provider Business Mailing Address Fax Number:
718-429-4556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9211 35TH AVE
Provider Second Line Business Practice Location Address:
SUITE 1E
Provider Business Practice Location Address City Name:
JACKSON HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11372-5866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-429-4555
Provider Business Practice Location Address Fax Number:
718-429-4556
Provider Enumeration Date:
01/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
FAUSTO
Authorized Official Middle Name:
ABRAHAM
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
718-429-4555

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  229968 , 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)

  • Identifier: 03131142 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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