Provider Demographics
NPI:1477217941
Name:MEDICAL CARE OF NY PC
Entity Type:Organization
Organization Name:MEDICAL CARE OF NY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIBERTO
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-360-4768
Mailing Address - Street 1:1915 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4605
Mailing Address - Country:US
Mailing Address - Phone:212-385-4949
Mailing Address - Fax:
Practice Address - Street 1:1915 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4605
Practice Address - Country:US
Practice Address - Phone:212-385-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty