Provider Demographics
NPI:1649562992
Name:NY SERVICE FOR INFECTIOUS DISEASES, MEDICAL P.C.
Entity Type:Organization
Organization Name:NY SERVICE FOR INFECTIOUS DISEASES, MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:P
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-518-9445
Mailing Address - Street 1:4373 UNION ST
Mailing Address - Street 2:SUITE C-B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3063
Mailing Address - Country:US
Mailing Address - Phone:718-886-3877
Mailing Address - Fax:718-886-3995
Practice Address - Street 1:4373 UNION ST
Practice Address - Street 2:SUITE C-B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3063
Practice Address - Country:US
Practice Address - Phone:718-886-3877
Practice Address - Fax:718-886-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234448261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service