Provider Demographics
NPI:1043393929
Name:FOREST HILLS MEDICAL PC
Entity Type:Organization
Organization Name:FOREST HILLS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPPADONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-441-0101
Mailing Address - Street 1:8340 WOODHAVEN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-441-0101
Mailing Address - Fax:718-441-0101
Practice Address - Street 1:8340 WOODHAVEN BOULEVARD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-441-0101
Practice Address - Fax:718-441-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05134Medicare ID - Type Unspecified