Provider Demographics
NPI:1376010769
Name:NASSAU QUEENS MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:NASSAU QUEENS MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:EISEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-307-1449
Mailing Address - Street 1:7535 31ST AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1846
Mailing Address - Country:US
Mailing Address - Phone:718-316-6870
Mailing Address - Fax:
Practice Address - Street 1:7535 31ST AVENUE
Practice Address - Street 2:SUITE 205
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370
Practice Address - Country:US
Practice Address - Phone:718-316-6870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty