Provider Demographics
NPI:1497294193
Name:REGINE MEDICAL PLLC
Entity Type:Organization
Organization Name:REGINE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAULIO
Authorized Official - Middle Name:F
Authorized Official - Last Name:COSME-THORMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-252-0818
Mailing Address - Street 1:2462 FLATBUSH AVE
Mailing Address - Street 2:#1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5013
Mailing Address - Country:US
Mailing Address - Phone:718-252-0818
Mailing Address - Fax:631-366-0391
Practice Address - Street 1:2462 FLATBUSH AVE
Practice Address - Street 2:#1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5013
Practice Address - Country:US
Practice Address - Phone:718-252-0818
Practice Address - Fax:631-366-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255151207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty