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General NPI Number Information
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NPI Number | 1427681782
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Entity Type | Organization
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Legal Business Name | BRTC NI INC
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 6315 83RD ST
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-1962
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Country | US
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Telephone | 646-269-1187
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Fax |
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Provider Business Mailing Address
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Address Line | 6315 83RD ST
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-1962
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FAMILY PRACTICE
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Name | MICHAEL CHRISTOPHER MOY
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Credential | DO
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Telephone | 718-205-5795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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