Provider Demographics
NPI:1629274972
Name:AIDS CENTER OF QUEENS COUNTY, INC.
Entity Type:Organization
Organization Name:AIDS CENTER OF QUEENS COUNTY, INC.
Other - Org Name:ACQC
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR, ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-896-2500
Mailing Address - Street 1:16121 JAMAICA AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-6113
Mailing Address - Country:US
Mailing Address - Phone:718-896-2500
Mailing Address - Fax:718-459-6542
Practice Address - Street 1:16121 JAMAICA AVE FL 6
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6113
Practice Address - Country:US
Practice Address - Phone:718-896-2500
Practice Address - Fax:718-459-6542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8219110A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01225456Medicaid
NY01551555Medicaid
NY01225456Medicaid