Provider Demographics
NPI:1861447864
Name:OUR CHOICE MEDICAL, P.C.
Entity Type:Organization
Organization Name:OUR CHOICE MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-896-4701
Mailing Address - Street 1:9932 66TH RD
Mailing Address - Street 2:LOBBY P
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4462
Mailing Address - Country:US
Mailing Address - Phone:718-896-4701
Mailing Address - Fax:718-896-5808
Practice Address - Street 1:9932 66TH RD
Practice Address - Street 2:LOBBY P
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4462
Practice Address - Country:US
Practice Address - Phone:718-896-4701
Practice Address - Fax:718-896-5808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01813827Medicaid