DEKALB MEDICAL GROUP PC
Ambulatory Health at Saint Nicholas Ave, Brooklyn, NY

License number
New York 193223
Category
Ambulatory Health
Type
Primary Care
Owner
Name: PETER YEE LO MD
Title: PRESIDENT
Phone: (718) 418-0700
Address
Address 2
122 Saint Nicholas Ave, Brooklyn, NY 11237
58 Irving St, Valley Stream, NY 11580
National Provider ID: 1205020930
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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DEKALB MEDICAL GROUP, PC

Brooklyn, NY

Status:
Inactive
Industry:
Internist
Doing business as:
Dekalb Medical Group
Inactive reason:
Dissolution by Proclamation / Annulment of Authority
Registration:
May 1, 2002
Inactive since:
Jan 27, 2010
Phone:
(718) 418-0700 (Phone)
Addresses:
122 St Nicholas Ave, Brooklyn, NY 11237 (Physical)
122 Saint Nicholas Ave, Brooklyn, NY 11237
State ID:
2761694
Business type:
DOMESTIC PROFESSIONAL CORPORATION
Peter Lo, 122 St Nicholas Ave, Brooklyn, NY 11237 (Physical)
Categories:
Group Medical Practice

Dekalb Medical Group, PC

58 Irving St, Valley Stream, NY 11580

Status:
Inactive
Industry:
Health/Allied Services
Principal:
Peter Lo Principal, inactive

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