Organization
SOP MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR BIENVENIDO FLORIMON DE LA ROSA (MEDICAL DIRECTOR)
(718) 898-1386
Entity
Organization
Contact information
Practice address
10211 ROOSEVELT AVE STE 4, CORONA, NY 11368-2331
(718) 898-1386
(718) 898-1093
Mailing address
10211 ROOSEVELT AVE STE 4, CORONA, NY 11368-2331
(718) 898-1386
(718) 898-1093
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02933219
—
NY
Enumeration date
08/07/2007
Last updated
04/07/2021
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