Provider Demographics
NPI:1164630448
Name:QUEENS MEDICAL SERVICES, P.C
Entity Type:Organization
Organization Name:QUEENS MEDICAL SERVICES, P.C
Other - Org Name:QUEENS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GUHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-505-1300
Mailing Address - Street 1:41 - 42 ELBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1620
Mailing Address - Country:US
Mailing Address - Phone:718-505-1300
Mailing Address - Fax:718-505-1883
Practice Address - Street 1:41 - 42 ELBERTSON ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1620
Practice Address - Country:US
Practice Address - Phone:718-505-1300
Practice Address - Fax:718-505-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217513207R00000X
NY199134207R00000X
NY202437208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04165Medicare UPIN