Provider Demographics
NPI:1639868763
Name:OCTOBER MEDICAL PC
Entity Type:Organization
Organization Name:OCTOBER MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:EVADNE
Authorized Official - Last Name:WALKER-ADAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-404-6550
Mailing Address - Street 1:3704 91ST ST STE D
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7909
Mailing Address - Country:US
Mailing Address - Phone:929-401-4936
Mailing Address - Fax:516-534-4666
Practice Address - Street 1:3704 91ST ST STE D
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7909
Practice Address - Country:US
Practice Address - Phone:929-401-4936
Practice Address - Fax:516-534-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty