Provider Demographics
NPI:1174673446
Name:MEDICAL OFFICE
Entity Type:Organization
Organization Name:MEDICAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ATTENTING
Authorized Official - Prefix:
Authorized Official - First Name:MERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-531-2540
Mailing Address - Street 1:1821 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5005
Mailing Address - Country:US
Mailing Address - Phone:718-531-2540
Mailing Address - Fax:718-531-2540
Practice Address - Street 1:1821 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5005
Practice Address - Country:US
Practice Address - Phone:718-531-2540
Practice Address - Fax:718-531-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195497261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01729666Medicaid
NY01729666Medicaid
NY65J711Medicare ID - Type Unspecified