Healthcare Provider Details

I. General information

NPI: 1265179238
Provider Name (Legal Business Name): MEDICAL CARE OF NY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 11/14/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78-15 LINDEN BOULEVARD UNIT B
HOWARD BEACH NY
11414
US

IV. Provider business mailing address

78-15 LINDEN BOULEVARD UNIT B
HOWARD BEACH NY
11414
US

V. Phone/Fax

Practice location:
  • Phone: 718-674-7896
  • Fax:
Mailing address:
  • Phone: 718-674-7896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: NIBERTO ANGEL MORENO
Title or Position: OWNER
Credential:
Phone: 786-360-4768