| Organization Name: | 63 ST MEDICAL HEATHCARE PC |
| NPI Number: | 1396012324 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAN ACARU (PRESIDENT) |
| Mailing Address: | 3939 63rd St # 1a Woodside |
| State: | NY US |
| Postal Code: | 113773648 |
| Phone Number: | 7182052992 |
| Fax Number: | |
| NPI Enumeration Date: | 11/18/2011 |
| NPI Last Update Date: | 11/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 141555 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |