| None | |
|
7554 Metropolitan Ave Middle Village NY 11379-2639 | |
| (718) 894-4200 | |
| (718) 894-3900 |
| Full Name | None |
|---|---|
| Speciality | Family Medicine |
| Location | 7554 Metropolitan Ave, Middle Village, New York |
| Authorized Official Name and Position | Gennadiy Kvetny (PHYSICIAN) |
| Authorized Official Contact | 7188944200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 7554 Metropolitan Ave Middle Village NY 11379-2639 Ph: (718) 894-4200 | None 7554 Metropolitan Ave Middle Village NY 11379-2639 Ph: (718) 894-4200 |
| NPI Number | 1376747378 |
|---|---|
| Provider Enumeration Date | 06/13/2007 |
| Last Update Date | 04/06/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376747378 | NPI | - | NPPES |
| 01897043 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 208977 (New York) | Primary |
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