| Monroe Primary Care Medical Pc | |
|
745 Route 17m Suite 202 Monroe NY 10950-2660 | |
| (845) 782-1714 | |
| (845) 782-6648 |
| Full Name | Monroe Primary Care Medical Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 745 Route 17m, Monroe, New York |
| Authorized Official Name and Position | Boris Lavotshkin (OWNER) |
| Authorized Official Contact | 8457821714 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Monroe Primary Care Medical Pc Po Box 834 Monroe NY 10949-0834 Ph: (845) 782-1714 | Monroe Primary Care Medical Pc 745 Route 17m Suite 202 Monroe NY 10950-2660 Ph: (845) 782-1714 |
| NPI Number | 1578631669 |
|---|---|
| Provider Enumeration Date | 11/30/2006 |
| Last Update Date | 07/06/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578631669 | NPI | - | NPPES |
| 02182598 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 61220 (New York) | Primary |
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