| Organization Name: | NORTHEASTERN MEDICAL HEALTH GROUP LLC. |
| NPI Number: | 1720308877 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VICTOR WILFREDO ROBLES PADRO (PRESIDENT) |
| Mailing Address: | Ave. General Valero 375 Edificio Esquina Medica Suite 103 Fajardo |
| State: | PR US |
| Postal Code: | 00738 |
| Phone Number: | 7875562725 |
| Fax Number: | 7879989898 |
| NPI Enumeration Date: | 06/10/2010 |
| NPI Last Update Date: | 06/10/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 16707 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |