Provider Demographics
NPI:1891103446
Name:758 MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:758 MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEONGPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-436-3023
Mailing Address - Street 1:758 56TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3504
Mailing Address - Country:US
Mailing Address - Phone:718-436-3023
Mailing Address - Fax:718-871-2805
Practice Address - Street 1:758 56TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3504
Practice Address - Country:US
Practice Address - Phone:718-436-3023
Practice Address - Fax:718-871-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical