Provider Demographics
NPI:1245432483
Name:JAMAICA HOSPITAL MEDICAL CENTER
Entity Type:Organization
Organization Name:JAMAICA HOSPITAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRIGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONTYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-206-6715
Mailing Address - Street 1:3304 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4352
Mailing Address - Country:US
Mailing Address - Phone:516-270-2126
Mailing Address - Fax:516-255-2006
Practice Address - Street 1:8900 VAN WYCK EXPY
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418-2897
Practice Address - Country:US
Practice Address - Phone:718-206-6715
Practice Address - Fax:718-206-6797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228112282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital