Provider Demographics
NPI:1669593562
Name:HISPANIOLA MEDICAL CARE, PC
Entity type:Organization
Organization Name:HISPANIOLA MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-234-0800
Mailing Address - Street 1:19 HAMILTON PLACE
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6885
Mailing Address - Country:US
Mailing Address - Phone:212-234-0800
Mailing Address - Fax:212-740-5163
Practice Address - Street 1:19 HAMILTON PLACE
Practice Address - Street 2:FLOOR 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-6885
Practice Address - Country:US
Practice Address - Phone:212-234-0800
Practice Address - Fax:212-740-5163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01974932Medicaid
NY01974932Medicaid
NYH10023Medicare UPIN
NY01974932Medicaid