Provider Demographics
NPI:1932699709
Name:MEDEA MEDICAL PC
Entity Type:Organization
Organization Name:MEDEA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OMARI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUBINIDZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-225-3001
Mailing Address - Street 1:6829 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GDNS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2632
Mailing Address - Country:US
Mailing Address - Phone:718-225-3001
Mailing Address - Fax:718-225-3002
Practice Address - Street 1:6829 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND GDNS
Practice Address - State:NY
Practice Address - Zip Code:11364-2632
Practice Address - Country:US
Practice Address - Phone:718-225-3001
Practice Address - Fax:718-225-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285269207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Single Specialty