MEDICARE: ADVANCED MEDICAL CARE OF NY, 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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1487912903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL CARE OF NY, PC

Provider Business Mailing Address
First Line	:	2060 UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 UTICA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3216
Country	:	US
Telephone Number	:	718-485-2420
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUAN SANDOVAL
Credential	:
Telephone Number	:	718-485-2420

Provider Enumeration Date	:	05/03/2012
Last Update Date	:	05/03/2012

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