Provider Demographics
NPI:1003323049
Name:RVC MEDICAL CONSULTATION PC
Entity Type:Organization
Organization Name:RVC MEDICAL CONSULTATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:TAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-734-6621
Mailing Address - Street 1:393 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14227 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2629
Practice Address - Country:US
Practice Address - Phone:718-964-3007
Practice Address - Fax:718-395-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1267052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty