Provider Demographics
NPI:1447597828
Name:CITIMEDICAL I PLLC
Entity Type:Organization
Organization Name:CITIMEDICAL I PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-255-6615
Mailing Address - Street 1:6336 99TH ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1941
Mailing Address - Country:US
Mailing Address - Phone:718-255-6615
Mailing Address - Fax:718-255-1394
Practice Address - Street 1:6336 99TH ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1941
Practice Address - Country:US
Practice Address - Phone:718-255-6615
Practice Address - Fax:718-255-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266873207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty