Provider Demographics
NPI:1275096570
Name:FAMILY MEDICAL HEALTH CARE PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL HEALTH CARE PLLC
Other - Org Name:FAMILY HEALTH CARE PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-645-9252
Mailing Address - Street 1:2116 BATH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4908
Mailing Address - Country:US
Mailing Address - Phone:347-645-9252
Mailing Address - Fax:
Practice Address - Street 1:2116 BATH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4908
Practice Address - Country:US
Practice Address - Phone:347-645-9252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty