| Corona Medical Pc | |
|
40-11 Warren St 2nd Floor Elmhurst NY 11373-1700 | |
| (718) 426-8100 | |
| (718) 396-0407 |
| Full Name | Corona Medical Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 40-11 Warren St, Elmhurst, New York |
| Authorized Official Name and Position | Afshin Tavakoly (OFFICER/PHYSICIAN) |
| Authorized Official Contact | 9176057233 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Corona Medical Pc Po Box 650067 Fresh Meadows NY 11365-0067 Ph: (917) 605-7233 | Corona Medical Pc 40-11 Warren St 2nd Floor Elmhurst NY 11373-1700 Ph: (718) 426-8100 |
| NPI Number | 1699026385 |
|---|---|
| Provider Enumeration Date | 09/21/2012 |
| Last Update Date | 10/30/2024 |
| Medicare PECOS PAC ID | 0749421279 |
|---|---|
| Medicare Enrollment ID | O20130726000094 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699026385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 207V00000X | Obstetrics & Gynecology | (* (Not Available)) | Secondary |
| Provider Name | Afshin Tavakoly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700059680 PECOS PAC ID: 0749315059 Enrollment ID: I20100311000806 |
| Provider Name | Sharon Kheradnam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063823664 PECOS PAC ID: 2567715378 Enrollment ID: I20210629003539 |
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