| Mamaroneck Medical, Pllc | |
|
933 Mamaroneck Ave Suite 102 Mamaroneck NY 10543-1662 | |
| (914) 523-1948 | |
| Not Available |
| Full Name | Mamaroneck Medical, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 933 Mamaroneck Ave, Mamaroneck, New York |
| Authorized Official Name and Position | Lili Kung (PHYSICIAN) |
| Authorized Official Contact | 9145231948 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mamaroneck Medical, Pllc Po Box 204 Mamaroneck NY 10543-0204 Ph: (914) 523-1948 | Mamaroneck Medical, Pllc 933 Mamaroneck Ave Suite 102 Mamaroneck NY 10543-1662 Ph: (914) 523-1948 |
| NPI Number | 1992101984 |
|---|---|
| Provider Enumeration Date | 11/18/2014 |
| Last Update Date | 07/06/2015 |
| Medicare PECOS PAC ID | 4486966967 |
|---|---|
| Medicare Enrollment ID | O20150713000928 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992101984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 218148 (New York) | Primary |
| Provider Name | Lili Kung |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104888221 PECOS PAC ID: 2365586963 Enrollment ID: I20100220000134 |
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