| Baxter Medical Care Pc | |
|
17121 Jamaica Ave Jamaica NY 11432-5427 | |
| (718) 521-4442 | |
| (718) 305-4568 |
| Full Name | Baxter Medical Care Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 17121 Jamaica Ave, Jamaica, New York |
| Authorized Official Name and Position | Addy Nnsewo (PRESIDENT) |
| Authorized Official Contact | 5162360336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Baxter Medical Care Pc 13130a Merrick Blvd Jamaica NY 11434-4134 Ph: (718) 233-2556 | Baxter Medical Care Pc 17121 Jamaica Ave Jamaica NY 11432-5427 Ph: (718) 521-4442 |
| NPI Number | 1801286679 |
|---|---|
| Provider Enumeration Date | 01/30/2015 |
| Last Update Date | 06/07/2022 |
| Medicare PECOS PAC ID | 4587967971 |
|---|---|
| Medicare Enrollment ID | O20160119001142 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801286679 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 234005 (New York) | Primary |
| Provider Name | Addy Nnsewo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396806097 PECOS PAC ID: 8022290295 Enrollment ID: I20110309000287 |
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