| Rd Medical Professional Services Pc | |
|
260 Christopher Ln Ste 102a Staten Island NY 10314-1631 | |
| (914) 295-9323 | |
| (315) 612-9793 |
| Full Name | Rd Medical Professional Services Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 260 Christopher Ln Ste 102a, Staten Island, New York |
| Authorized Official Name and Position | Camila Mendez (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 9142959323 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rd Medical Professional Services Pc 20980 Cipres Way Boca Raton FL 33433-1604 Ph: (914) 295-9323 | Rd Medical Professional Services Pc 260 Christopher Ln Ste 102a Staten Island NY 10314-1631 Ph: (914) 295-9323 |
| NPI Number | 1811643166 |
|---|---|
| Provider Enumeration Date | 02/25/2022 |
| Last Update Date | 01/02/2024 |
| Medicare PECOS PAC ID | 8628463296 |
|---|---|
| Medicare Enrollment ID | O20220317000374 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811643166 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Paulette Taka Lanneaux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508292525 PECOS PAC ID: 8628291275 Enrollment ID: I20140529000115 |
| Provider Name | Sofia T Gamidova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326481276 PECOS PAC ID: 7618119413 Enrollment ID: I20150202001484 |
| Provider Name | Rivka Weiss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952859969 PECOS PAC ID: 7618243312 Enrollment ID: I20171025000878 |
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