| Broadway Internal Medicine P.c | |
|
7517 41st Avenue Elmhurts NY 11373 | |
| (718) 803-6300 | |
| (718) 803-0085 |
| Full Name | Broadway Internal Medicine P.c |
|---|---|
| Speciality | Clinic/Center |
| Location | 7517 41st Avenue, Elmhurts, New York |
| Authorized Official Name and Position | Carlos Manuel Gonzalez (PHYSICIAN) |
| Authorized Official Contact | 7188036300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Internal Medicine P.c 7517 41st Ave Elmhurst NY 11373-1004 Ph: (718) 803-6300 | Broadway Internal Medicine P.c 7517 41st Avenue Elmhurts NY 11373 Ph: (718) 803-6300 |
| NPI Number | 1124265848 |
|---|---|
| Provider Enumeration Date | 01/16/2009 |
| Last Update Date | 01/16/2009 |
| Medicare PECOS PAC ID | 7012185473 |
|---|---|
| Medicare Enrollment ID | O20110729000547 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124265848 | NPI | - | NPPES |
| 1437162024 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | 156591 (New York) | Primary |
| Provider Name | Carlos M Gonzalez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437162054 PECOS PAC ID: 9739210014 Enrollment ID: I20100630000542 |
| Provider Name | Luz D Ares |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588680565 PECOS PAC ID: 0648442897 Enrollment ID: I20111011000767 |