Provider Demographics
NPI:1669807574
Name:CEDARS MEDICAL, P.C.
Entity type:Organization
Organization Name:CEDARS MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIE
Authorized Official - Middle Name:TAPIA
Authorized Official - Last Name:AGUSTIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:718-779-5588
Mailing Address - Street 1:60-40 82 STREET
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379
Mailing Address - Country:US
Mailing Address - Phone:718-779-5588
Mailing Address - Fax:718-779-5585
Practice Address - Street 1:6040 82ND ST
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-5335
Practice Address - Country:US
Practice Address - Phone:718-779-5588
Practice Address - Fax:718-779-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196473174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty