Healthcare Provider Details

I. General information

NPI: 1568422210
Provider Name (Legal Business Name): OUR NEIGHBORHOOD MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 QUEENS BLVD SUITE 303
SUNNYSIDE NY
11104-1660
US

IV. Provider business mailing address

3777 INDEPENDENCE AVE SUITE 15F
BRONX NY
10463-1409
US

V. Phone/Fax

Practice location:
  • Phone: 718-707-3434
  • Fax: 718-707-3435
Mailing address:
  • Phone: 718-707-3434
  • Fax: 718-707-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: GHEORGHE R GANEA
Title or Position: PRESIDENT
Credential: MD
Phone: 718-707-3434