Healthcare Provider Details

I. General information

NPI: 1609025964
Provider Name (Legal Business Name): METRO PHYSICIAN ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11014 JAMAICA AVE
RICHMOND HILL NY
11418-2320
US

IV. Provider business mailing address

PO BOX 1816
NEW YORK NY
10159-1816
US

V. Phone/Fax

Practice location:
  • Phone: 212-475-8066
  • Fax: 212-475-4175
Mailing address:
  • Phone: 212-475-8066
  • Fax: 212-475-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number114071
License Number StateNY

VIII. Authorized Official

Name: DR. KENNETH JOHN HERWIG II
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 212-475-8066