Provider Demographics
NPI:1568422210
Name:OUR NEIGHBORHOOD MEDICAL PC
Entity Type:Organization
Organization Name:OUR NEIGHBORHOOD MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GHEORGHE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GANEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-707-3434
Mailing Address - Street 1:3777 INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 15F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1409
Mailing Address - Country:US
Mailing Address - Phone:718-707-3434
Mailing Address - Fax:718-707-3435
Practice Address - Street 1:4701 QUEENS BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1660
Practice Address - Country:US
Practice Address - Phone:718-707-3434
Practice Address - Fax:718-707-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-26
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty