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General NPI Number Information
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NPI Number | 1326348608
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Entity Type | Organization
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Legal Business Name | MEDICAL PROFESSIONAL GROUP
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 3110 37TH AVE STE 203
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-2112
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Country | US
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Telephone | 718-433-0044
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Fax | 718-433-4644
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Provider Business Mailing Address
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Address Line | 3110 37TH AVE STE 202
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-2112
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Country | US
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Telephone | 718-433-0044
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Fax | 718-255-6555
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | GINA DUVAL
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Credential |
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Telephone | 718-433-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 163744
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License Number State | NY
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