Provider Demographics
NPI:1023184512
Name:DOCTORS MEDICAL GROUP OF NY PC
Entity Type:Organization
Organization Name:DOCTORS MEDICAL GROUP OF NY PC
Other - Org Name:DOCTORS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLUNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFEVRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-364-3200
Mailing Address - Street 1:15144 82ND ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1777
Mailing Address - Country:US
Mailing Address - Phone:718-364-3200
Mailing Address - Fax:718-364-3800
Practice Address - Street 1:392 BEDFORD PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2415
Practice Address - Country:US
Practice Address - Phone:718-364-3200
Practice Address - Fax:718-364-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWHW311Medicare ID - Type UnspecifiedUNTIED STATES