Provider Demographics
NPI:1124205570
Name:WOODSIDE MEDICAL CARE P.C
Entity Type:Organization
Organization Name:WOODSIDE MEDICAL CARE P.C
Other - Org Name:PARSONS MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DO YOUNG
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-446-6579
Mailing Address - Street 1:6019 ROOSEVELT AVE. 201
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3537
Mailing Address - Country:US
Mailing Address - Phone:718-446-6579
Mailing Address - Fax:718-446-1213
Practice Address - Street 1:6019 ROOSEVELT AVE. 201
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3537
Practice Address - Country:US
Practice Address - Phone:718-446-6579
Practice Address - Fax:718-446-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02104149Medicaid