Provider Demographics
NPI:1316543085
Name:CITIMED COMPLETE MEDICAL CARE PC
Entity Type:Organization
Organization Name:CITIMED COMPLETE MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-509-9424
Mailing Address - Street 1:6336 99TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1979
Mailing Address - Country:US
Mailing Address - Phone:718-509-9424
Mailing Address - Fax:
Practice Address - Street 1:6555 WOODHAVEN BLVD FL 2
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5048
Practice Address - Country:US
Practice Address - Phone:718-255-6515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty