Provider Demographics
NPI:1871735241
Name:NEIGHBORHOOD FAMILY WELLNESS MEDICAL P.C.
Entity type:Organization
Organization Name:NEIGHBORHOOD FAMILY WELLNESS MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ETERI
Authorized Official - Middle Name:
Authorized Official - Last Name:TETROK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-293-2626
Mailing Address - Street 1:3706 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456
Mailing Address - Country:US
Mailing Address - Phone:718-293-2626
Mailing Address - Fax:
Practice Address - Street 1:3706 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-293-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ214065-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1699850909OtherINDIVIDUAL NPI NUMBER