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General NPI Number Information
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NPI Number | 1669807574
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Entity Type | Organization
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Legal Business Name | CEDARS MEDICAL, P.C.
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 6040 82ND ST
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-5335
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Country | US
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Telephone | 718-779-5588
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Fax | 718-779-5585
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Provider Business Mailing Address
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Address Line | 60-40 82 STREET
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379
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Country | US
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Telephone | 718-779-5588
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Fax | 718-779-5585
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ERIE TAPIA AGUSTIN SR.
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Credential | MD
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Telephone | 718-779-5588
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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 | 196473
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License Number State | NY
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