| Innocare Medical Pc | |
|
4160 Main St Ste 203 Flushing NY 11355-3899 | |
| (718) 290-5810 | |
| Not Available |
| Full Name | Innocare Medical Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4160 Main St Ste 203, Flushing, New York |
| Authorized Official Name and Position | Jin Song (CEO) |
| Authorized Official Contact | 7182136214 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innocare Medical Pc 14109 28th Ave Apt 2b Flushing NY 11354-1601 Ph: () - | Innocare Medical Pc 4160 Main St Ste 203 Flushing NY 11355-3899 Ph: (718) 290-5810 |
| NPI Number | 1871054320 |
|---|---|
| Provider Enumeration Date | 03/27/2019 |
| Last Update Date | 03/11/2020 |
| Medicare PECOS PAC ID | 6002157260 |
|---|---|
| Medicare Enrollment ID | O20190416002494 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871054320 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jin Song |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720312531 PECOS PAC ID: 0840454674 Enrollment ID: I20170725000264 |
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