Provider Demographics
NPI:1538306352
Name:JUNCTION MEDICAL OFFICE, P.C.
Entity Type:Organization
Organization Name:JUNCTION MEDICAL OFFICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FAUSTO
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-429-4555
Mailing Address - Street 1:9211 35TH AVE
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5866
Mailing Address - Country:US
Mailing Address - Phone:718-429-4555
Mailing Address - Fax:718-429-4556
Practice Address - Street 1:9211 35TH AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5866
Practice Address - Country:US
Practice Address - Phone:718-429-4555
Practice Address - Fax:718-429-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03131142Medicaid
NYI03126Medicare UPIN
NY03131142Medicaid