Provider Demographics
NPI:1073733085
Name:JUNCTION CLINIC OF PEDIATRICS,ELMHURST HOSPITAL
Entity Type:Organization
Organization Name:JUNCTION CLINIC OF PEDIATRICS,ELMHURST HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT - ATTENDING
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ATANASSOVA-LINEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-334-6170
Mailing Address - Street 1:6510 79TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2717
Mailing Address - Country:US
Mailing Address - Phone:646-642-0196
Mailing Address - Fax:
Practice Address - Street 1:6510 79TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2717
Practice Address - Country:US
Practice Address - Phone:646-642-0196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229545261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care