Central Park Physical Medicine PC

NPI #1174848501 in Laurelton, New York

Provider Information

NPI Number: 1174848501
Entity Type: Organization
Organization Name: Central Park Physical Medicine PC
Primary Specialty: Specialist
Enumeration Date: Mar 29, 2010
Last Updated: Mar 30, 2015

Practice Location

Address: 21714 MERRICK BLVD
City: Laurelton
State: New York
ZIP Code: 11413-1917
Phone: (347) 270-8353

Authorized Official

Name: SAMUEL MICHAEL THEAGENE, MD
Title: OWNER
Phone: (347) 270-8353

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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