Provider Demographics
NPI:1336467125
Name:RAY MIRANDA MEDICAL HEALTHCARE PC
Entity Type:Organization
Organization Name:RAY MIRANDA MEDICAL HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-359-3777
Mailing Address - Street 1:142-25 37TH AVE.
Mailing Address - Street 2:C2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6531
Mailing Address - Country:US
Mailing Address - Phone:718-359-3777
Mailing Address - Fax:
Practice Address - Street 1:142-25 37TH AVE.
Practice Address - Street 2:C2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6531
Practice Address - Country:US
Practice Address - Phone:718-359-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty