Provider Demographics
NPI:1518139393
Name:JR MEDICAL & DIAGNOSTIC SERVIDES P.C.
Entity Type:Organization
Organization Name:JR MEDICAL & DIAGNOSTIC SERVIDES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:I
Authorized Official - Last Name:RODRIGUEZ-OSPINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-665-4392
Mailing Address - Street 1:8 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8722
Mailing Address - Country:US
Mailing Address - Phone:631-665-4392
Mailing Address - Fax:631-665-5008
Practice Address - Street 1:8 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8722
Practice Address - Country:US
Practice Address - Phone:631-665-4392
Practice Address - Fax:631-665-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01181382Medicaid
NY50F241Medicare PIN
NYE78037Medicare UPIN