Provider Demographics
NPI:1346607868
Name:PRIORITY MEDICAL GROUP P.C.
Entity Type:Organization
Organization Name:PRIORITY MEDICAL GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YURY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-206-4420
Mailing Address - Street 1:16204 JAMAICA AVE
Mailing Address - Street 2:5
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4907
Mailing Address - Country:US
Mailing Address - Phone:718-206-4420
Mailing Address - Fax:718-206-4423
Practice Address - Street 1:16204 JAMAICA AVE
Practice Address - Street 2:5
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4907
Practice Address - Country:US
Practice Address - Phone:718-206-4420
Practice Address - Fax:718-206-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1723671173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty