Organization
LEGACY MEDICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MADHU BOPPANA M.D, (OWNER)
(646) 270-1050
Entity
Organization
Contact information
Practice address
3741 77TH ST, JACKSON HTS, NY 11372-6629
(718) 406-9588
Mailing address
245 8TH AVE # 101, NEW YORK, NY 10011-1607
(646) 270-1050
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
199052-1
NY
Other
Enumeration date
08/17/2012
Last updated
02/25/2020
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