Provider Demographics
NPI:1952745291
Name:123 MEDICAL GROUP, P.C.
Entity type:Organization
Organization Name:123 MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALCIBIADES
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-543-1800
Mailing Address - Street 1:286 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE# 1G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1315
Mailing Address - Country:US
Mailing Address - Phone:212-543-1800
Mailing Address - Fax:
Practice Address - Street 1:286 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE# 1G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1315
Practice Address - Country:US
Practice Address - Phone:212-543-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty