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General NPI Number Information
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NPI Number | 1720270358
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Entity Type | Organization
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Legal Business Name | BETHESDAMD CARE
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 13516 NORTHERN BLVD
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City | FLUSHING
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State | NY
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Zip | 11354-4007
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Country | US
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Telephone | 516-330-6579
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Fax |
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Provider Business Mailing Address
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Address Line | 13516 NORTHERN BLVD
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City | FLUSHING
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State | NY
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Zip | 11354-4007
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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 | MANAGER
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Name | MR. WARREN TAI
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Credential | DO
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Telephone | 516-330-6579
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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 | 229673
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License Number State | NY
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