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1588157788
96TH STREET JUNCTION BLVD MEDICAL PC
CORONA, NY
NPI
1588157788
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Entity Type
Organization
Authorized Contact
WILDER RUCKER
Owner
718-606-1199
Organization Subpart ?
No
Primary Taxonomy
207Q00000X Family Medicine
Enumeration Date
2018-06-12
Last Update Date
2018-08-13
Business Address
96TH STREET JUNCTION BLVD MEDICAL PC
5548 96TH ST
CORONA, NY 11368
Phone number: 718-606-1199
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Mailing Address
96TH STREET JUNCTION BLVD MEDICAL PC
5548 96TH ST
CORONA, NY 11368-3009
Phone number:
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