Provider Demographics
NPI:1699963033
Name:A MEDICAL OFFICE, PLLC
Entity type:Organization
Organization Name:A MEDICAL OFFICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:
Authorized Official - Last Name:GOROHOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-714-3874
Mailing Address - Street 1:17 HARMON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2707
Mailing Address - Country:US
Mailing Address - Phone:718-336-3500
Mailing Address - Fax:
Practice Address - Street 1:1811 QUENTIN RD
Practice Address - Street 2:#1H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1343
Practice Address - Country:US
Practice Address - Phone:718-336-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01867394Medicaid
NYG75737Medicare UPIN
NY01867394Medicaid
NY06533Medicare PIN