Provider Demographics
NPI:1982889648
Name:PARKVILLE MEDICAL PC
Entity Type:Organization
Organization Name:PARKVILLE MEDICAL PC
Other - Org Name:PARCARE MEDICAL & HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-963-0800
Mailing Address - Street 1:445 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2735
Mailing Address - Country:US
Mailing Address - Phone:718-963-0800
Mailing Address - Fax:718-534-5221
Practice Address - Street 1:445 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2735
Practice Address - Country:US
Practice Address - Phone:718-963-0800
Practice Address - Fax:718-534-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158543207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01332223Medicaid
NY03305346Medicaid
NYWZ9Z51Medicare PIN
NYA62310Medicare UPIN
NY03305346Medicaid