MEDICARE: PLAZA MEDICAL, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	097922-1	NY

General Provider Information

NPI Number	:	1720018948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAZA MEDICAL, P.C.

Provider Business Mailing Address
First Line	:	6410 VETERANS AVE
Second Line	:	SUITE 103
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5639
Country	:	US
Telephone Number	:	718-209-6400
Fax Number	:	718-209-6060

Provider Business Practice Location Address
First Line	:	6410 VETERANS AVE
Second Line	:	SUITE 103
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5639
Country	:	US
Telephone Number	:	718-209-6400
Fax Number	:	718-209-6060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE RAMON QUINONES JR.
Credential	:	M.D.
Telephone Number	:	718-209-4455

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	09/15/2009

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