Healthcare Provider Details

I. General information

NPI: 1275625428
Provider Name (Legal Business Name): NY TOTAL MEDICAL CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 9TH ST
BROOKLYN NY
11215-4008
US

IV. Provider business mailing address

362 9TH ST
BROOKLYN NY
11215-4008
US

V. Phone/Fax

Practice location:
  • Phone: 718-499-6099
  • Fax: 718-499-6391
Mailing address:
  • Phone: 718-499-6099
  • Fax: 718-499-6391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JORGE SERJE
Title or Position: OWNER
Credential: M.D.
Phone: 718-499-6099