Organization
COMMUNITY INTERNAL MEDICINE ASSOC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARISSA SANTOS MD (COOWNER)
(212) 255-2333
Entity
Organization
Contact information
Practice address
9777 QUEENS BLVD, 9TH FL STE 900, REGO PARK, NY 11374-3317
(212) 255-2333
Mailing address
9777 QUEENS BLVD, 9TH FL STE 900, REGO PARK, NY 11374-3317
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
198043
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5816203
AETNA
NY
Enumeration date
03/20/2007
Last updated
08/22/2020
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