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General NPI Number Information
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NPI Number | 1669834297
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE CHOICE MEDICAL TESTING P.C
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 211 RICHMOND ST
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City | BROOKLYN
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State | NY
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Zip | 11208-1945
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Country | US
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Telephone | 718-268-2158
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Fax |
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Provider Business Mailing Address
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Address Line | P.O BOX #29 3070 BRIGHTON 1ST STREET
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City | BROOKLYN
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State | NY
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Zip | 11235-8070
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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 | OWNER
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Name | CHARLES MASTER
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Credential | M.D
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Telephone | 718-268-2158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 211094-1
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License Number State | NY
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