MEDICARE: REFRESHING MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1184998015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REFRESHING MEDICAL PC

Provider Business Mailing Address
First Line	:	21429 JAMAICA AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1733
Country	:	US
Telephone Number	:	718-465-4540
Fax Number	:

Provider Business Practice Location Address
First Line	:	21429 JAMAICA AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1733
Country	:	US
Telephone Number	:	718-465-4540
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KARL E LATORTUE
Credential	:	MD
Telephone Number	:	718-875-4200

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	02/23/2012

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Directions to “REFRESHING MEDICAL PC ” Practice Location

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