Provider Demographics
NPI:1366816415
Name:QUALITY MEDICAL FITNESS, PC
Entity Type:Organization
Organization Name:QUALITY MEDICAL FITNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-424-1170
Mailing Address - Street 1:389 FORT SALONGA RD STE 3
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3044
Mailing Address - Country:US
Mailing Address - Phone:631-424-1170
Mailing Address - Fax:631-424-1171
Practice Address - Street 1:389 FORT SALONGA RD STE 3
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3044
Practice Address - Country:US
Practice Address - Phone:631-424-1170
Practice Address - Fax:631-424-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY238113OtherNEW YORK STATE LICENSE