Provider Demographics
NPI:1093988222
Name:UNION TPKE MEDICAL PC
Entity Type:Organization
Organization Name:UNION TPKE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:M
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-380-0011
Mailing Address - Street 1:15034 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3928
Mailing Address - Country:US
Mailing Address - Phone:718-380-0011
Mailing Address - Fax:718-820-0841
Practice Address - Street 1:15034 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3928
Practice Address - Country:US
Practice Address - Phone:718-380-0011
Practice Address - Fax:718-820-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203378261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty