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General NPI Number Information
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NPI Number | 1578065249
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Entity Type | Organization
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Legal Business Name | MSAN MEDICAL CARE PC
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 6861 FRESH POND RD
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5263
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Country | US
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Telephone | 718-576-3354
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Fax | 715-576-3505
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Provider Business Mailing Address
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Address Line | 6861 FRESH POND RD
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5263
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Country | US
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Telephone | 718-576-3354
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Fax | 715-576-3505
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Authorized Official
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Title or Position | PRESIDENT
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Name | MYAT SAN
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Credential | M.D.
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Telephone | 718-576-3354
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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 | 231830
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License Number State | NY
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