Juan a Medina Medical Office PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

245701 Issued in NY

Legal business name

JUAN A MEDINA MEDICAL OFFICE PC

Practice address

870 Central Ave
Far Rockaway, NY 11691-4660

Phone

(718) 327-3458

Fax

(718) 337-2390

NPI assigned

Aug 6, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Juan Antonio Medina, MD

Title

President

Phone

(718) 327-3458

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281052800000",
    "number": "1477868032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 CENTRAL AVE",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116914660",
            "telephone_number": "718-327-3458",
            "fax_number": "718-337-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 CENTRAL AVE",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116914660",
            "telephone_number": "718-327-3458",
            "fax_number": "718-337-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUAN A MEDINA MEDICAL OFFICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-06",
        "last_updated": "2010-08-06",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "ANTONIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-327-3458",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "245701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02989077",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Far Rockaway, NY
• Providers in Far Rockaway, NY by specialty
• Primary Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.