Organization
JUAN A MEDINA MEDICAL OFFICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN ANTONIO MEDINA MD (PRESIDENT)
(718) 327-3458
Entity
Organization
Contact information
Practice address
870 CENTRAL AVE, FAR ROCKAWAY, NY 11691-4660
(718) 327-3458
(718) 337-2390
Mailing address
870 CENTRAL AVE, FAR ROCKAWAY, NY 11691-4660
(718) 327-3458
(718) 337-2390
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
245701
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02989077
—
NY
Enumeration date
08/06/2010
Last updated
08/06/2010
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