Provider Demographics
NPI:1003952235
Name:PEDIATRIC HEALTHCARE OF QUEENS PC
Entity Type:Organization
Organization Name:PEDIATRIC HEALTHCARE OF QUEENS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOUIZOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-278-9500
Mailing Address - Street 1:3014 37TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3809
Mailing Address - Country:US
Mailing Address - Phone:718-278-9500
Mailing Address - Fax:718-278-2430
Practice Address - Street 1:27 47 CRESCENT STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102
Practice Address - Country:US
Practice Address - Phone:718-278-9500
Practice Address - Fax:718-278-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170828208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A60552Medicare UPIN