Provider Demographics
NPI:1114679248
Name:METRO-EASTERN PHYSICIAN GROUP L.L.C.
Entity Type:Organization
Organization Name:METRO-EASTERN PHYSICIAN GROUP L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:ORTIZ BUSTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-893-3411
Mailing Address - Street 1:PO BOX 1945
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1945
Mailing Address - Country:US
Mailing Address - Phone:787-893-3411
Mailing Address - Fax:
Practice Address - Street 1:41 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3149
Practice Address - Country:US
Practice Address - Phone:787-893-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty