Individual
MR. MICHAEL UNDAZAN MAGSUCI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
7901 BROADWAY, ELMHURST, NY 11373-1329
(718) 334-4000
Mailing address
6914 41ST AVE, 306, WOODSIDE, NY 11377-4028
(718) 974-3353
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F306020
NY
Other
Enumeration date
03/21/2012
Last updated
03/21/2012
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