Provider Demographics
NPI:1215384912
Name:MEDICAL OFFICE
Entity Type:Organization
Organization Name:MEDICAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:SIMPAO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:718-388-7283
Mailing Address - Street 1:765 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5797
Mailing Address - Country:US
Mailing Address - Phone:718-388-7283
Mailing Address - Fax:718-963-3410
Practice Address - Street 1:765 GRAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5797
Practice Address - Country:US
Practice Address - Phone:718-388-7283
Practice Address - Fax:718-963-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1623982080A0000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty