MEDICARE: BRTC NI INC

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	:	1427681782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRTC NI INC

Provider Business Mailing Address
First Line	:	6315 83RD ST
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-1962
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6315 83RD ST
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-1962
Country	:	US
Telephone Number	:	646-269-1187
Fax Number	:

Authorized Official
Title or Position	:	FAMILY PRACTICE
Name	:	MICHAEL CHRISTOPHER MOY
Credential	:	DO
Telephone Number	:	718-205-5795

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	02/14/2020

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Directions to “BRTC NI INC ” Practice Location

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