Provider Demographics
NPI:1174707616
Name:REGO PARK MEDICAL SERVICES, P.C.
Entity type:Organization
Organization Name:REGO PARK MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOVANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-429-6630
Mailing Address - Street 1:6135 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2739
Mailing Address - Country:US
Mailing Address - Phone:718-429-6630
Mailing Address - Fax:718-429-6584
Practice Address - Street 1:6135 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2739
Practice Address - Country:US
Practice Address - Phone:718-429-6630
Practice Address - Fax:718-429-6584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153423-1207T00000X
NY153643-2207X00000X
NY025361-1208100000X
NY148343-2208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty