| Sop Medical Pc | |
|
10211 Roosevelt Ave Ste 4 Corona NY 11368-2331 | |
| (718) 898-1386 | |
| (718) 898-1093 |
| Full Name | Sop Medical Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10211 Roosevelt Ave Ste 4, Corona, New York |
| Authorized Official Name and Position | Hector Bienvenido Florimon De La Rosa (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7188981386 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sop Medical Pc 10211 Roosevelt Ave Ste 4 Corona NY 11368-2331 Ph: (718) 898-1386 | Sop Medical Pc 10211 Roosevelt Ave Ste 4 Corona NY 11368-2331 Ph: (718) 898-1386 |
| NPI Number | 1083805741 |
|---|---|
| Provider Enumeration Date | 08/07/2007 |
| Last Update Date | 04/07/2021 |
| Medicare PECOS PAC ID | 5294827549 |
|---|---|
| Medicare Enrollment ID | O20070816000632 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083805741 | NPI | - | NPPES |
| 02933219 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Hector B Florimon De La Rosa |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649337858 PECOS PAC ID: 5890705693 Enrollment ID: I20060425000030 |
| Provider Name | Glendalyz Alberto |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366733719 PECOS PAC ID: 7113160078 Enrollment ID: I20130826000674 |
| Provider Name | Maria Gabriela Ponce Garcia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124453105 PECOS PAC ID: 3072810910 Enrollment ID: I20191008001039 |
| Provider Name | Tatiana F Gomez Lopez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578947750 PECOS PAC ID: 3779814322 Enrollment ID: I20191011001258 |
| Provider Name | Roberto A Moran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528550647 PECOS PAC ID: 0840601043 Enrollment ID: I20220622003076 |
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