=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194355586
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED MEDICAL PRACTICE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2020
-----------------------------------------------------
Last Update Date | 06/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17933 90TH AVE
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-4763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-657-2706
-----------------------------------------------------
Fax | 718-657-2420
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7704 BROADWAY
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11373-1927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-565-3144
-----------------------------------------------------
Fax | 718-639-6409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | ZENAIDA ESPINO SANTOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-565-0444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------