Healthcare Provider Details

I. General information

NPI: 1396458725
Provider Name (Legal Business Name): MEDICAL CARE OF NY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1387 CASTLE HILL AVE STE 6
BRONX NY
10462-4833
US

IV. Provider business mailing address

1387 CASTLE HILL AVE STE 6
BRONX NY
10462-4833
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-4200
  • Fax: 718-931-8869
Mailing address:
  • Phone: 718-931-4200
  • Fax: 718-931-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NIBERTO ANGEL MORENO
Title or Position: AO
Credential:
Phone: 305-662-5200