| Village Family Practice, Pc | |
|
30 5th Ave New York NY 10011-8859 | |
| (212) 477-1750 | |
| Not Available |
| Full Name | Village Family Practice, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 30 5th Ave, New York, New York |
| Authorized Official Name and Position | Jerry Clements (PRESIDENT) |
| Authorized Official Contact | 2124771750 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Village Family Practice, Pc 30 5th Ave New York NY 10011-8859 Ph: (212) 477-1750 | Village Family Practice, Pc 30 5th Ave New York NY 10011-8859 Ph: (212) 477-1750 |
| NPI Number | 1902048911 |
|---|---|
| Provider Enumeration Date | 04/06/2009 |
| Last Update Date | 04/22/2010 |
| Medicare PECOS PAC ID | 0648328682 |
|---|---|
| Medicare Enrollment ID | O20090501000291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902048911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 166889 (New York) | Primary |
| Provider Name | Jerry Clements |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285721662 PECOS PAC ID: 7113075151 Enrollment ID: I20090501000268 |
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