Provider Demographics
NPI:1598925604
Name:QUEENS PEDIATRIC SERVICES, P.C.
Entity Type:Organization
Organization Name:QUEENS PEDIATRIC SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUTFA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-868-8282
Mailing Address - Street 1:1847 MOTT AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4201
Mailing Address - Country:US
Mailing Address - Phone:718-868-8282
Mailing Address - Fax:718-471-2865
Practice Address - Street 1:1847 MOTT AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4201
Practice Address - Country:US
Practice Address - Phone:718-868-8282
Practice Address - Fax:718-471-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty