Basic Information
| Provider Information | |||||||||
| NPI: | 1275847675 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL CHOICE AND OPTIONS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13876 QUEENS BLVD | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | BRIARWOOD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114352930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188506345 | ||||||||
| FaxNumber: | 7185594895 | ||||||||
| Practice Location | |||||||||
| Address1: | 13876 QUEENS BLVD | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | BRIARWOOD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114352930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188506345 | ||||||||
| FaxNumber: | 7185594895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2010 | ||||||||
| LastUpdateDate: | 07/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | BLUMSTEIN | ||||||||
| AuthorizedOfficialFirstName: | CLIFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PRACTICE | ||||||||
| AuthorizedOfficialTelephone: | 7188506345 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | GYN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 151215 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 01006977 | 05 | NY | MEDICAID |