Provider Demographics
NPI:1154898187
Name:MEDPRO MOVIL LLC
Entity type:Organization
Organization Name:MEDPRO MOVIL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SADIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-739-1400
Mailing Address - Street 1:1024 PENINSULA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1542
Mailing Address - Country:US
Mailing Address - Phone:718-739-1400
Mailing Address - Fax:800-732-1219
Practice Address - Street 1:16808 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4341
Practice Address - Country:US
Practice Address - Phone:718-739-1400
Practice Address - Fax:800-732-1219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty