Provider Demographics
NPI:1396458725
Name:MEDICAL CARE OF NY PC
Entity type:Organization
Organization Name:MEDICAL CARE OF NY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:NIBERTO
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-662-5200
Mailing Address - Street 1:1387 CASTLE HILL AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4833
Mailing Address - Country:US
Mailing Address - Phone:718-931-4200
Mailing Address - Fax:718-931-8869
Practice Address - Street 1:1387 CASTLE HILL AVE STE 6
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4833
Practice Address - Country:US
Practice Address - Phone:718-931-4200
Practice Address - Fax:718-931-8869
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL CARE OF NY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-30
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty