| Rrg Medical Practice, Pc | |
|
3736 90th St Fl 1 Jackson Heights NY 11372-7830 | |
| (718) 505-0030 | |
| (718) 505-0032 |
| Full Name | Rrg Medical Practice, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3736 90th St Fl 1, Jackson Heights, New York |
| Authorized Official Name and Position | Rafael Rodriguez (PHYSICIAN) |
| Authorized Official Contact | 7185050030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rrg Medical Practice, Pc 9001a Roosevelt Ave 2nd Floor Jackson Heights NY 11372-7938 Ph: (718) 505-0030 | Rrg Medical Practice, Pc 3736 90th St Fl 1 Jackson Heights NY 11372-7830 Ph: (718) 505-0030 |
| NPI Number | 1720383714 |
|---|---|
| Provider Enumeration Date | 01/21/2011 |
| Last Update Date | 09/24/2019 |
| Medicare PECOS PAC ID | 2961683776 |
|---|---|
| Medicare Enrollment ID | O20110228000569 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720383714 | NPI | - | NPPES |
| 02461109 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Rafael Rodriguez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144298175 PECOS PAC ID: 4284528696 Enrollment ID: I20040209000308 |
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