Provider Demographics
NPI:1992204903
Name:NY FAMILY MEDICAL DOCS PC
Entity Type:Organization
Organization Name:NY FAMILY MEDICAL DOCS PC
Other - Org Name:NY FAMILY MEDICAL DOCS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FELICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBIASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-805-8768
Mailing Address - Street 1:PO BOX 211226
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-6226
Mailing Address - Country:US
Mailing Address - Phone:718-805-0037
Mailing Address - Fax:347-960-9468
Practice Address - Street 1:7602 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1850
Practice Address - Country:US
Practice Address - Phone:718-805-0037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty