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General NPI Number Information
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NPI Number | 1639868763
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Entity Type | Organization
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Legal Business Name | OCTOBER MEDICAL PC
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Dates
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Enumeration Date | 05/04/2023
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 3704 91ST ST STE D
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7909
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Country | US
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Telephone | 929-401-4936
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Fax | 516-534-4666
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Provider Business Mailing Address
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Address Line | 3704 91ST ST STE D
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7909
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Country | US
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Telephone | 929-401-4936
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Fax | 516-534-4666
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Authorized Official
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Title or Position | DO
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Name | SONIA EVADNE WALKER-ADAMSON
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Credential | DO
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Telephone | 516-404-6550
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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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