Quality Medical Fitness, Pc | |
389 Fort Salonga Rd Ste 3 Northport NY 11768-3044 | |
(631) 424-1170 | |
(631) 424-1171 |
Full Name | Quality Medical Fitness, Pc |
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Speciality | Internal Medicine |
Location | 389 Fort Salonga Rd Ste 3, Northport, New York |
Authorized Official Name and Position | Vijay B. Gopal (PRESIDENT) |
Authorized Official Contact | 6314241170 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Quality Medical Fitness, Pc 389 Fort Salonga Rd Ste 3 Northport NY 11768-3044 Ph: (631) 424-1170 | Quality Medical Fitness, Pc 389 Fort Salonga Rd Ste 3 Northport NY 11768-3044 Ph: (631) 424-1170 |
NPI Number | 1366816415 |
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Provider Enumeration Date | 11/30/2015 |
Last Update Date | 11/30/2015 |
Medicare PECOS PAC ID | 8325337744 |
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Medicare Enrollment ID | O20160525000198 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366816415 | NPI | - | NPPES |
238113 | Other | NY | NEW YORK STATE LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 238113 (New York) | Primary |
Provider Name | Harold Avella |
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Provider Type | Practitioner - Physical Medicine And Rehabilitation |
Provider Identifiers | NPI Number: 1770502965 PECOS PAC ID: 6103861174 Enrollment ID: I20050621001101 |
Provider Name | Behrouz Farahmandpour |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1447246756 PECOS PAC ID: 4981634516 Enrollment ID: I20050815000132 |
Provider Name | Vijay B Gopal |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1336158187 PECOS PAC ID: 5597761569 Enrollment ID: I20061014000007 |
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