Provider Demographics
NPI:1053646901
Name:TRIBOROUGH MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:TRIBOROUGH MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIPPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:718-658-2448
Mailing Address - Street 1:16405 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4140
Mailing Address - Country:US
Mailing Address - Phone:718-658-2448
Mailing Address - Fax:718-658-2603
Practice Address - Street 1:16405 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4140
Practice Address - Country:US
Practice Address - Phone:718-658-2448
Practice Address - Fax:718-658-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty