| 9317 Medical Office Pc | |
|
9317 Roosevelt Ave Jackson Heights NY 11372-7943 | |
| (718) 446-0270 | |
| (718) 446-5939 |
| Full Name | 9317 Medical Office Pc |
|---|---|
| Speciality | Pediatrics |
| Location | 9317 Roosevelt Ave, Jackson Heights, New York |
| Authorized Official Name and Position | Sandra J Marrero (OFFICE MANAGER) |
| Authorized Official Contact | 7184460270 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 9317 Medical Office Pc 9317 Roosevelt Ave Jackson Heights NY 11372-7943 Ph: (718) 446-0270 | 9317 Medical Office Pc 9317 Roosevelt Ave Jackson Heights NY 11372-7943 Ph: (718) 446-0270 |
| NPI Number | 1871707372 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2860645397 |
|---|---|
| Medicare Enrollment ID | O20130114000232 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871707372 | NPI | - | NPPES |
| 01748636 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| Provider Name | Alain A Sosa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770503393 PECOS PAC ID: 0446213789 Enrollment ID: I20041108001254 |
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