Provider Demographics
NPI:1578858940
Name:ROOSEVELT MEDICAL SERVICES P C
Entity Type:Organization
Organization Name:ROOSEVELT MEDICAL SERVICES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:RODRIGO
Authorized Official - Last Name:HARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-426-9486
Mailing Address - Street 1:6709 ROOSEVELT AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2923
Mailing Address - Country:US
Mailing Address - Phone:718-426-9486
Mailing Address - Fax:718-426-9302
Practice Address - Street 1:6709 ROOSEVELT AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2923
Practice Address - Country:US
Practice Address - Phone:718-426-9486
Practice Address - Fax:718-426-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty