| Mvp Medical Practice Pc | |
|
475 Atlantic Ave Ste 2 Brooklyn NY 11217-4383 | |
| (718) 369-4850 | |
| (718) 369-4851 |
| Full Name | Mvp Medical Practice Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 475 Atlantic Ave Ste 2, Brooklyn, New York |
| Authorized Official Name and Position | Lyle Honig Mojica (CFO) |
| Authorized Official Contact | 3238605305 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mvp Medical Practice Pc 6255 W Sunset Blvd Fl 21 Los Angeles CA 90028-7422 Ph: (323) 498-6686 | Mvp Medical Practice Pc 475 Atlantic Ave Ste 2 Brooklyn NY 11217-4383 Ph: (718) 369-4850 |
| NPI Number | 1912541061 |
|---|---|
| Provider Enumeration Date | 11/01/2019 |
| Last Update Date | 06/19/2024 |
| Medicare PECOS PAC ID | 5395970362 |
|---|---|
| Medicare Enrollment ID | O20131029000201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912541061 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Alan J Stein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831145648 PECOS PAC ID: 4486553831 Enrollment ID: I20040105000512 |
| Provider Name | Marcelo Venegas Pizarro |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245431204 PECOS PAC ID: 5890687354 Enrollment ID: I20040329000637 |
| Provider Name | Ricky K Hsu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568491967 PECOS PAC ID: 5193712545 Enrollment ID: I20040427001756 |
| Provider Name | Orin A Douglas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487810636 PECOS PAC ID: 4789718321 Enrollment ID: I20100817001636 |
| Provider Name | Nicole Parsons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174953269 PECOS PAC ID: 1658661236 Enrollment ID: I20160610000149 |
| Provider Name | Eric Leach-rodriguez De Arriba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902008550 PECOS PAC ID: 3274814009 Enrollment ID: I20170110000320 |
| Provider Name | Erik P Mortensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902055965 PECOS PAC ID: 1456635655 Enrollment ID: I20170308000603 |
| Provider Name | Travis Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750806204 PECOS PAC ID: 3870853898 Enrollment ID: I20180212001187 |
| Provider Name | Michael Duane Williams |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477939304 PECOS PAC ID: 3173892288 Enrollment ID: I20200316001108 |
| Provider Name | Marissa Ashley Willoughby-naiditch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194283911 PECOS PAC ID: 9234560061 Enrollment ID: I20200512001702 |
| Provider Name | Sarah Zuercher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013323088 PECOS PAC ID: 5193146371 Enrollment ID: I20200526000388 |
| Provider Name | Roxanne Cox-iyamu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326172255 PECOS PAC ID: 9335285030 Enrollment ID: I20201209002308 |
| Provider Name | Shani Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427620558 PECOS PAC ID: 9638567183 Enrollment ID: I20211102002305 |
| Provider Name | Eunae Ko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003272865 PECOS PAC ID: 1951721554 Enrollment ID: I20220211000814 |
| Provider Name | Bryan Gaudio |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679865885 PECOS PAC ID: 6204154701 Enrollment ID: I20230728002244 |
| Provider Name | Razan Aama Alawadhi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821742230 PECOS PAC ID: 1658768643 Enrollment ID: I20240123003940 |
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