Basic Information
| Provider Information | |||||||||
| NPI: | 1699032268 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RS MEDICAL OFFICE P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2152 STARLING AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104624303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185979020 | ||||||||
| FaxNumber: | 7185979022 | ||||||||
| Practice Location | |||||||||
| Address1: | 2152 STARLING AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104624303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185979020 | ||||||||
| FaxNumber: | 7185979022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2012 | ||||||||
| LastUpdateDate: | 06/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | SABUR | ||||||||
| AuthorizedOfficialFirstName: | RUMANA | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 7185979020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 226201 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 02370969 | 05 | NY | MEDICAID |