Roman Koldayev Medical P C | |
310 Woods Ave Oceanside NY 11572-2146 | |
(718) 909-7665 | |
Not Available |
Full Name | Roman Koldayev Medical P C |
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Speciality | Internal Medicine |
Location | 310 Woods Ave, Oceanside, New York |
Authorized Official Name and Position | Roman Koldayev (PRESIDENT) |
Authorized Official Contact | 7189097665 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Roman Koldayev Medical P C 310 Woods Ave Oceanside NY 11572-2146 Ph: (718) 909-7665 | Roman Koldayev Medical P C 310 Woods Ave Oceanside NY 11572-2146 Ph: (718) 909-7665 |
NPI Number | 1649604810 |
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Provider Enumeration Date | 08/24/2013 |
Last Update Date | 08/24/2013 |
Medicare PECOS PAC ID | 1759602196 |
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Medicare Enrollment ID | O20150610001402 |
Identifier | Type | State | Issuer |
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1649604810 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | 206990 (New York) | Primary |
Provider Name | Roman Koldayev |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1790766970 PECOS PAC ID: 2264411719 Enrollment ID: I20040717000168 |
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