Provider Demographics
NPI:1205246410
Name:BISHOP MEDICAL PC
Entity type:Organization
Organization Name:BISHOP MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:OTTONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-523-7186
Mailing Address - Street 1:8515 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1879
Mailing Address - Country:US
Mailing Address - Phone:718-523-7186
Mailing Address - Fax:718-206-1370
Practice Address - Street 1:8515 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1879
Practice Address - Country:US
Practice Address - Phone:718-523-7186
Practice Address - Fax:718-206-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244387261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center