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General NPI Number Information
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NPI Number | 1811943228
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Entity Type | Organization
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Legal Business Name | MIGRACE MEDICAL PRACTICE PC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 982 COLUMBUS AVE
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City | NEW YORK
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State | NY
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Zip | 10025-2501
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Country | US
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Telephone | 212-862-9046
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1828
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City | NEW YORK
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State | NY
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Zip | 10027-8801
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Country | US
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Telephone | 212-862-9046
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MIGUEL AVILA-RONDON
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Credential | MD
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Telephone | 212-862-9046
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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 | 193694
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License Number State | NY
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