MEDICARE: 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1891441226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CARE OF NY PC

Provider Business Mailing Address
First Line	:	2244 CHURCH AVE FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4195
Country	:	US
Telephone Number	:	718-352-0083
Fax Number	:	718-627-1525

Provider Business Practice Location Address
First Line	:	2244 CHURCH AVE FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4195
Country	:	US
Telephone Number	:	718-352-0083
Fax Number	:	718-627-1525

Authorized Official
Title or Position	:	OWNER
Name	:	NIBERTO ANGEL MORENO
Credential	:
Telephone Number	:	786-360-4768

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	09/28/2022

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