Provider Demographics
NPI:1417085507
Name:R & L MEDICAL ASSOCIATES, P C
Entity Type:Organization
Organization Name:R & L MEDICAL ASSOCIATES, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-637-8651
Mailing Address - Street 1:984 N BROADWAY
Mailing Address - Street 2:SUITE L05
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1318
Mailing Address - Country:US
Mailing Address - Phone:914-968-6588
Mailing Address - Fax:
Practice Address - Street 1:984 N BROADWAY
Practice Address - Street 2:SUITE L05
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1318
Practice Address - Country:US
Practice Address - Phone:914-968-6588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127412174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00530350Medicaid
NY00530350Medicaid