Basic Information
| Provider Information | |||||||||
| NPI: | 1306123740 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICARDO ISSA PHYSICIAN PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1141 SHORE PKWY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112145813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127721211 | ||||||||
| FaxNumber: | 2122492421 | ||||||||
| Practice Location | |||||||||
| Address1: | 157 E 72ND ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100214331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127721211 | ||||||||
| FaxNumber: | 2122492421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2011 | ||||||||
| LastUpdateDate: | 11/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | ISSA | ||||||||
| AuthorizedOfficialFirstName: | RICARDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2127721211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 215565 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.