Provider Demographics
NPI:1942364286
Name:CITI MEDICAL OF CANARSIE P.C.
Entity Type:Organization
Organization Name:CITI MEDICAL OF CANARSIE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-209-8002
Mailing Address - Street 1:1954 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5506
Mailing Address - Country:US
Mailing Address - Phone:718-209-8002
Mailing Address - Fax:718-209-4744
Practice Address - Street 1:1954 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5506
Practice Address - Country:US
Practice Address - Phone:718-209-8002
Practice Address - Fax:718-209-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEP951Medicare ID - Type UnspecifiedGROUP MEDICARE #