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Organization
SOUTH BEACH MEDICAL PC
Active
Organization
SOUTH BEACH MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN E GARCIA (CONTROLLER)
(718) 869-7641
Entity
Organization
Contact information
Practice address
327 BEACH 19TH ST, FAR ROCKAWAY, NY 11691-4423
(718) 869-7641
(718) 869-8507
Mailing address
PO BOX 1389, FAR ROCKAWAY, NY 11690-1389
(718) 869-7641
(718) 869-8507
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
910124000045
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01246928
—
NY
Enumeration date
09/20/2006
Last updated
08/22/2020
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