Provider Demographics
NPI:1851992242
Name:MEDICAL SPECIALTY CLINIC LLC
Entity Type:Organization
Organization Name:MEDICAL SPECIALTY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARNECO TIFAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-948-3269
Mailing Address - Street 1:1012 AVE PETER AGAPITO ORTIZ
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-948-3269
Mailing Address - Fax:
Practice Address - Street 1:1012 AVE PETER AGAPITO ORTIZ
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-948-3269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty