MEDICARE: WEBSTER URGENT CARE, 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	261QU0200X	Urgent Care Clinic/Center	213359-1	NY

General Provider Information

NPI Number	:	1487177572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEBSTER URGENT CARE, P.C.

Provider Business Mailing Address
First Line	:	20 LIVINGSTON AVE UNIT 401
Second Line	:
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-1991
Country	:	US
Telephone Number	:	732-890-3393
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 WEBSTER AVENUE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456
Country	:	US
Telephone Number	:	646-627-7747
Fax Number	:	646-627-7219

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MERVIN GRIFFIN
Credential	:	MD
Telephone Number	:	646-627-7747

Provider Enumeration Date	:	07/20/2017
Last Update Date	:	06/20/2018

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