MEDICARE: HISPANIOLA MEDICAL CARE, 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	261QP2300X	Primary Care Clinic/Center	210980	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265431183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HISPANIOLA MEDICAL CARE, PC

Provider Business Mailing Address
First Line	:	19 HAMILTON PL
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-6801
Country	:	US
Telephone Number	:	212-234-0800
Fax Number	:	212-234-2223

Provider Business Practice Location Address
First Line	:	19 HAMILTON PL
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-6801
Country	:	US
Telephone Number	:	212-234-0800
Fax Number	:	212-234-2223

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. FRANCISCO EUSEBIO ROSARIO-AMARO
Credential	:	MEDICINE DOCTOR
Telephone Number	:	212-234-0800

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/22/2020

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