Provider Demographics
NPI:1477505220
Name:JAMAICA HOSPITAL
Entity Type:Organization
Organization Name:JAMAICA HOSPITAL
Other - Org Name:JAMAICA HOSPITAL EMERGENCY DEPARTMENT - RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOUNIR
Authorized Official - Middle Name:F
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:718-240-5773
Mailing Address - Street 1:80 MARCUS DR
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT.
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:631-391-7797
Mailing Address - Fax:631-454-4163
Practice Address - Street 1:8900 VAN WYCK EXPWY
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418-2897
Practice Address - Country:US
Practice Address - Phone:718-206-8918
Practice Address - Fax:631-454-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01616320Medicaid
NY01616320Medicaid