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General NPI Number Information
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NPI Number | 1760533376
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Entity Type | Organization
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Legal Business Name | UNIVERSAL MEDICAL PRACTICE PC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 05/06/2009
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Provider Practice Location Address
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Address Line | 11034 70TH RD
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City | FOREST HILLS
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State | NY
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Zip | 11375-3934
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Country | US
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Telephone | 718-672-1100
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Fax | 718-672-7770
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Provider Business Mailing Address
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Address Line | PO BOX 270
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-0270
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Country | US
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Telephone | 631-264-2035
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Fax | 631-264-1418
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NIDIA ROSA CARRERO
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Credential | MD
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Telephone | 718-672-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 212687
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License Number State | NY
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