Provider Demographics
NPI:1083082069
Name:MONTAGUE URGENT MEDICAL CARE P.C
Entity Type:Organization
Organization Name:MONTAGUE URGENT MEDICAL CARE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:P
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-242-4333
Mailing Address - Street 1:109 MONTAGUE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3437
Mailing Address - Country:US
Mailing Address - Phone:212-242-4333
Mailing Address - Fax:212-242-4389
Practice Address - Street 1:109 MONTAGUE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3437
Practice Address - Country:US
Practice Address - Phone:212-242-4333
Practice Address - Fax:212-242-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205420261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01822499Medicaid