Healthcare Provider Details

I. General information

NPI: 1285714865
Provider Name (Legal Business Name): MIDTOWN MEDICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8618 18TH AVE
BROOKLYN NY
11214-3702
US

IV. Provider business mailing address

8618 18TH AVE
BROOKLYN NY
11214-3702
US

V. Phone/Fax

Practice location:
  • Phone: 718-259-2706
  • Fax: 718-621-9799
Mailing address:
  • Phone: 718-259-2706
  • Fax: 718-621-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number161596
License Number StateNY

VIII. Authorized Official

Name: DR. RONALD VINCENT GOVERNALE I
Title or Position: OWNER
Credential: M.D.
Phone: 718-259-2706