Provider Demographics
NPI:1265473110
Name:QPH, INC
Entity Type:Organization
Organization Name:QPH, INC
Other - Org Name:D/B/A HOLLISWOOD HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESKENAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CASAC, CPHQ
Authorized Official - Phone:718-776-8181
Mailing Address - Street 1:8737 PALERMO ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1221
Mailing Address - Country:US
Mailing Address - Phone:718-776-8181
Mailing Address - Fax:718-776-8551
Practice Address - Street 1:8737 PALERMO ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1221
Practice Address - Country:US
Practice Address - Phone:718-776-8181
Practice Address - Fax:718-776-8551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7643020283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004202OtherBLUE CROSS
NY01428197Medicaid
NY334055Medicare ID - Type Unspecified