Basic Information
| Provider Information | |||||||||
| NPI: | 1992204903 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NY FAMILY MEDICAL DOCS PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NY FAMILY MEDICAL DOCS PC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 211226 | ||||||||
| Address2: | |||||||||
| City: | WOODHAVEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114216226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188050037 | ||||||||
| FaxNumber: | 3479609468 | ||||||||
| Practice Location | |||||||||
| Address1: | 7602 JAMAICA AVE | ||||||||
| Address2: | |||||||||
| City: | WOODHAVEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114211850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188050037 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | DIBIASE | ||||||||
| AuthorizedOfficialFirstName: | FELICE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7188058768 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.