Provider Demographics
NPI:1982674388
Name:GEORGESCU MICHAEL
Entity Type:Organization
Organization Name:GEORGESCU MICHAEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGESCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-784-2277
Mailing Address - Street 1:69 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-2007
Mailing Address - Country:US
Mailing Address - Phone:718-784-2277
Mailing Address - Fax:
Practice Address - Street 1:142 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2621
Practice Address - Country:US
Practice Address - Phone:718-784-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005655173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty