Provider Demographics
NPI:1629792296
Name:MEDICAL CARE OF NY PC
Entity Type:Organization
Organization Name:MEDICAL CARE OF NY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIBERTO
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-360-4768
Mailing Address - Street 1:138-44 QUEENS BOULEVARD
Mailing Address - Street 2:STORES #3 AND #4
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2653
Mailing Address - Country:US
Mailing Address - Phone:718-715-1828
Mailing Address - Fax:718-715-1938
Practice Address - Street 1:138-44 QUEENS BOULEVARD
Practice Address - Street 2:STORES #3 AND #4
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2653
Practice Address - Country:US
Practice Address - Phone:718-715-1828
Practice Address - Fax:718-715-1938
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL CARE OF NY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-28
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty