Provider Demographics
NPI:1982839833
Name:NEIGHBORHOOD FAMILY MEDICAL WELLNESS PC
Entity Type:Organization
Organization Name:NEIGHBORHOOD FAMILY MEDICAL WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ETERI
Authorized Official - Middle Name:
Authorized Official - Last Name:TETROK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-293-2626
Mailing Address - Street 1:4006 3RD AVE
Mailing Address - Street 2:P.O. BOX 570-392
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7533
Mailing Address - Country:US
Mailing Address - Phone:718-293-2626
Mailing Address - Fax:718-293-2627
Practice Address - Street 1:3706 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-2145
Practice Address - Country:US
Practice Address - Phone:718-293-2626
Practice Address - Fax:718-293-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214065302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization