Organization
DIVINE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUGUSTINE UMEOZOR (CEO/MEDICAL DIRECTOR)
(917) 742-2442
Entity
Organization
Contact information
Practice address
13163 233RD ST # 1, ROSEDALE, NY 11422-1305
(718) 525-3347
Mailing address
13163 233RD ST # 1, ROSEDALE, NY 11422-1305
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02208982
—
NY
Enumeration date
04/12/2020
Last updated
04/12/2020
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