| Four Corners Medical Pc | |
|
11622 Metropolitan Ave Richmond Hill NY 11418-1017 | |
| (347) 415-7347 | |
| (347) 312-7197 |
| Full Name | Four Corners Medical Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 11622 Metropolitan Ave, Richmond Hill, New York |
| Authorized Official Name and Position | Jean-yves Dastain (PROVIDER) |
| Authorized Official Contact | 3474157347 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Four Corners Medical Pc 11622 Metropolitan Ave Richmond Hill NY 11418-1017 Ph: (347) 415-7347 | Four Corners Medical Pc 11622 Metropolitan Ave Richmond Hill NY 11418-1017 Ph: (347) 415-7347 |
| NPI Number | 1356071526 |
|---|---|
| Provider Enumeration Date | 06/12/2022 |
| Last Update Date | 03/01/2023 |
| Medicare PECOS PAC ID | 0345605291 |
|---|---|
| Medicare Enrollment ID | O20230427001035 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356071526 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Salvatore Trazzera |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1568469757 PECOS PAC ID: 4981691789 Enrollment ID: I20040426000906 |
| Provider Name | Adam S Budzikowski |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1790725125 PECOS PAC ID: 4385692912 Enrollment ID: I20050110000991 |
| Provider Name | Kashyar Khodabakhsh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1073788667 PECOS PAC ID: 0840477428 Enrollment ID: I20110608000094 |
| Provider Name | Jean Yves Dastain |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1417213299 PECOS PAC ID: 0143479576 Enrollment ID: I20120928000661 |
| Provider Name | Paul M Madaj |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1679994396 PECOS PAC ID: 9830494756 Enrollment ID: I20170224001443 |
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