Provider Demographics
NPI:1679749808
Name:GODWIN MEDICAL PC
Entity Type:Organization
Organization Name:GODWIN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:ALTAGRACIA
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-587-4020
Mailing Address - Street 1:3054 GODWIN TER
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5312
Mailing Address - Country:US
Mailing Address - Phone:347-587-4020
Mailing Address - Fax:
Practice Address - Street 1:3054 GODWIN TER
Practice Address - Street 2:SUITE A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5312
Practice Address - Country:US
Practice Address - Phone:347-587-4020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237247261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI48503Medicare UPIN