Provider Demographics
NPI:1912076563
Name:RAMON A MOQUETE, MD PC
Entity Type:Organization
Organization Name:RAMON A MOQUETE, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOQUETE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-568-6972
Mailing Address - Street 1:248 AUDUBON AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6332
Mailing Address - Country:US
Mailing Address - Phone:212-568-6972
Mailing Address - Fax:212-568-2821
Practice Address - Street 1:248 AUDUBON AVE
Practice Address - Street 2:STE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6332
Practice Address - Country:US
Practice Address - Phone:212-568-6972
Practice Address - Fax:212-568-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189122207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01714185Medicaid
NYA100001216Medicare PIN
NY07L182Medicare PIN
NY01714185Medicaid
NY07L1878841Medicare PIN