Organization
BROADWAY INTERNAL MEDICINE P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARLOS MANUEL GONZALEZ M.D (PHYSICIAN)
(718) 803-6300
Entity
Organization
Contact information
Practice address
7517 41ST AVENUE, ELMHURTS, NY 11373
(718) 803-6300
(718) 803-0085
Mailing address
7517 41ST AVE, ELMHURST, NY 11373-1004
(718) 803-6300
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
156591
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437162024
—
NY
Enumeration date
01/16/2009
Last updated
01/16/2009
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