| Legacy Medical Pllc | |
|
3741 77th St Jackson Hts NY 11372-6629 | |
| (718) 406-9588 | |
| Not Available |
| Full Name | Legacy Medical Pllc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 3741 77th St, Jackson Hts, New York |
| Authorized Official Name and Position | Madhu Boppana (OWNER) |
| Authorized Official Contact | 6462701050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Medical Pllc 245 8th Ave # 101 New York NY 10011-1607 Ph: (646) 270-1050 | Legacy Medical Pllc 3741 77th St Jackson Hts NY 11372-6629 Ph: (718) 406-9588 |
| NPI Number | 1457609653 |
|---|---|
| Provider Enumeration Date | 08/17/2012 |
| Last Update Date | 02/25/2020 |
| Certification Date | 02/25/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457609653 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 199052-1 (New York) | Primary |
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