Provider Demographics
NPI:1568771525
Name:DALTON MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:DALTON MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:718-888-9829
Mailing Address - Street 1:136-20 38 AVE
Mailing Address - Street 2:SUITE 6F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-888-9829
Mailing Address - Fax:718-888-9796
Practice Address - Street 1:13620 38TH AVE
Practice Address - Street 2:SUITE 6F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4233
Practice Address - Country:US
Practice Address - Phone:718-888-9829
Practice Address - Fax:718-888-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214851-1261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical