| Broadway Internal Medicine Associates P.c. | |
|
585 Broadway Massapequa NY 11758 | |
| (516) 797-1234 | |
| (516) 797-0190 |
| Full Name | Broadway Internal Medicine Associates P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 585 Broadway, Massapequa, New York |
| Authorized Official Name and Position | Charles K Miceli (PRES) |
| Authorized Official Contact | 5167971234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Internal Medicine Associates P.c. 585 Broadway Massapequa NY 11758 Ph: (516) 797-1234 | Broadway Internal Medicine Associates P.c. 585 Broadway Massapequa NY 11758 Ph: (516) 797-1234 |
| NPI Number | 1952446189 |
|---|---|
| Provider Enumeration Date | 02/21/2007 |
| Last Update Date | 09/26/2007 |
| Medicare PECOS PAC ID | 0143315804 |
|---|---|
| Medicare Enrollment ID | O20070926001096 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952446189 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Stanley Fox |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780673566 PECOS PAC ID: 8224063938 Enrollment ID: I20050930000747 |
| Provider Name | Mathew T Chengot |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1831147511 PECOS PAC ID: 1254366768 Enrollment ID: I20060105000144 |
| Provider Name | Robert M Marcus |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619958931 PECOS PAC ID: 5395830764 Enrollment ID: I20070929000102 |
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