Organization
MAIN STREET MEDICAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORA HARTOFILIS (ACTING DIRECTOR, BILLING)
(718) 661-8711
Entity
Organization
Contact information
Practice address
5645 MAIN ST, FLUSHING, NY 11355-5045
(718) 670-1234
Mailing address
PO BOX 27842, NEW YORK, NY 10087-7842
(718) 661-8711
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
2084N0400X
Neurology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01115737
—
NY
Enumeration date
02/23/2006
Last updated
12/22/2010
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