NPI | 1487059515 |
---|---|
Former Legal Business Name | MOSHOLU MEDICAL GROUP P.C |
Entity Type | Organization |
Authorized Contact | THEODORE COSTA DOCU Owner 718-601-0627 |
Organization Subpart ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 182886) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 245895) |
Enumeration Date | 2014-10-31 |
Last Update Date | 2020-07-14 |