Provider Demographics
NPI:1245791086
Name:NY QUEENS NP ADULT HEALTH CARE PC
Entity Type:Organization
Organization Name:NY QUEENS NP ADULT HEALTH CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YUNKYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:JEONG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-841-7392
Mailing Address - Street 1:7311 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3046
Mailing Address - Country:US
Mailing Address - Phone:718-841-7392
Mailing Address - Fax:
Practice Address - Street 1:7311 41ST AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3046
Practice Address - Country:US
Practice Address - Phone:718-841-7392
Practice Address - Fax:718-424-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty