| Divine Medical Llc | |
|
13163 233rd St # 1 Rosedale NY 11422-1305 | |
| (718) 525-3347 | |
| Not Available |
| Full Name | Divine Medical Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 13163 233rd St # 1, Rosedale, New York |
| Authorized Official Name and Position | Augustine Umeozor (CEO/MEDICAL DIRECTOR) |
| Authorized Official Contact | 9177422442 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Medical Llc 13163 233rd St # 1 Rosedale NY 11422-1305 Ph: () - | Divine Medical Llc 13163 233rd St # 1 Rosedale NY 11422-1305 Ph: (718) 525-3347 |
| NPI Number | 1952920795 |
|---|---|
| Provider Enumeration Date | 04/12/2020 |
| Last Update Date | 04/12/2020 |
| Medicare PECOS PAC ID | 2264862739 |
|---|---|
| Medicare Enrollment ID | O20200423002779 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952920795 | NPI | - | NPPES |
| 02208982 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Augustine U Umeozor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326069428 PECOS PAC ID: 1355335795 Enrollment ID: I20040409000270 |
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