Individual
DR. WALTER ANDREW MEDINA SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6370 110TH ST, FOREST HILLS, NY 11375-1440
(718) 833-8052
(718) 833-8968
Mailing address
6370 110TH ST, FOREST HILLS, NY 11375-1440
(718) 833-8052
(718) 833-8968
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
206169
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01744632
—
NY
Enumeration date
07/26/2006
Last updated
07/08/2007
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