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Organization

ECHENIQUE MEDICAL OFFICE PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. EVELIO ECHENIQUE MD (PRESIDENT)
(718) 762-6640
Entity
Organization

Contact information

Practice address
41-15 162ND STREET, FLUSHING, NY 11358-4124
(718) 762-6640
(718) 762-6635
Mailing address
41-15 162ND STREET, FLUSHING, NY 11358-4124
(718) 762-6640
(718) 762-6635

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
212182
NY
251S00000X
Community/Behavioral Health Agency

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02457472
NY
01
05095
MEDICARE ID#
NY
Enumeration date
02/04/2010
Last updated
04/18/2012
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