Provider Demographics
NPI:1407068018
Name:QUEENS DIAGNOSTIC & PREVENTIVE CARDIAC PC
Entity Type:Organization
Organization Name:QUEENS DIAGNOSTIC & PREVENTIVE CARDIAC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIU
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:DUBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-359-5901
Mailing Address - Street 1:157-08 45TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-359-5901
Mailing Address - Fax:718-939-2022
Practice Address - Street 1:157-08 45TH AVENUE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-359-5901
Practice Address - Fax:718-939-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1144202080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00207462Medicaid
00Medicare ID - Type Unspecified
B77889Medicare UPIN