Provider Demographics
NPI:1093759326
Name:KEW GARDENS FAMILY PHYSICIANS, LLP
Entity Type:Organization
Organization Name:KEW GARDENS FAMILY PHYSICIANS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PAROLISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-849-0624
Mailing Address - Street 1:11940 METROPOLITAN AVE
Mailing Address - Street 2:SUITE E1
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2600
Mailing Address - Country:US
Mailing Address - Phone:718-849-0624
Mailing Address - Fax:718-849-4935
Practice Address - Street 1:11940 METROPOLITAN AVE
Practice Address - Street 2:SUITE E1
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2600
Practice Address - Country:US
Practice Address - Phone:718-849-0624
Practice Address - Fax:718-849-4935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172844, 171010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01656Medicare PIN