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NPI Code Detail

MEDICARE: METRO PHYSICAL MEDICINE PC

MEDICARE: METRO PHYSICAL MEDICINE 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
1174400000XSpecialist194218NY

Other Identifiers

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

General Provider Information

NPI Number : 1679903413
Entity Type Code : Organization
Provider Name (Legal Business Name) : METRO PHYSICAL MEDICINE PC
Provider Business Mailing Address
First Line : 10825 MERRICK BLVD
Second Line :
City : JAMAICA
State : NY
Zip : 11433-2906
Country : US
Telephone Number : 718-658-9700
Fax Number : 718-658-9703
Provider Business Practice Location Address
First Line : 10825 MERRICK BLVD
Second Line :
City : JAMAICA
State : NY
Zip : 11433-2906
Country : US
Telephone Number : 718-658-9700
Fax Number : 718-658-9703
Authorized Official
Title or Position : OWNER
Name : DR. SAMUEL THEAGENE
Credential : M.D.
Telephone Number : 718-658-9700
Provider Enumeration Date : 11/14/2013
Last Update Date : 11/14/2013

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Directions to “METRO PHYSICAL MEDICINE PC ” Practice Location

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