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General NPI Number Information
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NPI Number | 1518102987
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Entity Type | Organization
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Legal Business Name | L&L CERVANTES MEDICAL PC
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 4322 50TH ST 2C
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City | WOODSIDE
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State | NY
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Zip | 11377-4442
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Country | US
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Telephone | 718-424-9292
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Fax |
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Provider Business Mailing Address
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Address Line | 7558 113TH ST SUITE 1A
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City | FOREST HILLS
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State | NY
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Zip | 11375-7427
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Country | US
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Telephone | 917-952-6397
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE
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Name | LOBER CERVANTES
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Credential | M.D
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Telephone | 917-952-6397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 234737
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License Number State | NY
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