Organization
112 GVR MEDICAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IDA TETRO MD (OWNER)
(718) 263-0200
Entity
Organization
Contact information
Practice address
6960 108TH ST, SUITE 108, FOREST HILLS, NY 11375-4323
(718) 263-0200
(718) 263-0205
Mailing address
6960 108TH ST, SUITE 108, FOREST HILLS, NY 11375-4323
(718) 263-0200
(718) 263-0205
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
220405
NY
Other
Enumeration date
02/20/2007
Last updated
08/22/2020
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