| 112 Gvr Medical, Pc | |
|
6960 108th St Suite 108 Forest Hills NY 11375-4323 | |
| (718) 263-0200 | |
| (718) 263-0205 |
| Full Name | 112 Gvr Medical, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 6960 108th St, Forest Hills, New York |
| Authorized Official Name and Position | Ida Tetro (OWNER) |
| Authorized Official Contact | 7182630200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 112 Gvr Medical, Pc 6960 108th St Suite 108 Forest Hills NY 11375-4323 Ph: (718) 263-0200 | 112 Gvr Medical, Pc 6960 108th St Suite 108 Forest Hills NY 11375-4323 Ph: (718) 263-0200 |
| NPI Number | 1649315771 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2567562168 |
|---|---|
| Medicare Enrollment ID | O20070711000918 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649315771 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 220405 (New York) | Primary |
| Provider Name | Ida Tetro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649315243 PECOS PAC ID: 6002822368 Enrollment ID: I20060224000171 |
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