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Organization
PHYSICIANS MEDICAL GROUP PC
Active
Organization
PHYSICIANS MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID WIEDER (ADMINISTRATOR)
(718) 436-7800
Entity
Organization
Contact information
Practice address
4303 14TH AVE, BROOKLYN, NY 11219-1429
(718) 436-7800
(718) 436-6507
Mailing address
4303 14TH AVENUE, BROOKLYN, NY 11219
(718) 436-7800
(718) 436-6507
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01106752
—
NY
Enumeration date
12/22/2005
Last updated
08/22/2020
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