Provider Demographics
NPI:1114477817
Name:GOOD MEDICAL CARE, PLLC
Entity Type:Organization
Organization Name:GOOD MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZEVALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-418-3335
Mailing Address - Street 1:672 DOGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3247
Mailing Address - Country:US
Mailing Address - Phone:718-418-3335
Mailing Address - Fax:718-418-6584
Practice Address - Street 1:351 ONDERDONK AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1334
Practice Address - Country:US
Practice Address - Phone:718-418-3335
Practice Address - Fax:718-418-6584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214540207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty