MEDICARE: CMORS MEDICAL, P.C.

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	210513	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	021579	OTHER	NY	MEDICAL LICENSE
2	028117	OTHER	NY	MEDICAL LICENSE
3	210513	OTHER	NY	LICENSE NUMBER

General Provider Information

NPI Number	:	1285794024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CMORS MEDICAL, P.C.

Provider Business Mailing Address
First Line	:	3130 GRAND CONCOURSE
Second Line	:	SUITE B4
City	:	BRONX
State	:	NY
Zip	:	10458-1213
Country	:	US
Telephone Number	:	718-367-8800
Fax Number	:	718-367-4047

Provider Business Practice Location Address
First Line	:	3130 GRAND CONCOURSE
Second Line	:	SUITE B4
City	:	BRONX
State	:	NY
Zip	:	10458-1213
Country	:	US
Telephone Number	:	718-367-8800
Fax Number	:	718-367-4047

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. THOMAS G OBRIEN II
Credential	:	D.O
Telephone Number	:	718-367-8800

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	02/12/2008

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Directions to “CMORS MEDICAL, P.C. ” Practice Location

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