Provider Demographics
NPI:1710009709
Name:NEW YORK HOSPITAL QUEENS
Entity Type:Organization
Organization Name:NEW YORK HOSPITAL QUEENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGOME
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:718-670-1517
Mailing Address - Street 1:9 COLLINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-5957
Mailing Address - Country:US
Mailing Address - Phone:845-259-3717
Mailing Address - Fax:
Practice Address - Street 1:56-45 MAIN STREET
Practice Address - Street 2:OBGYN DEPT.
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11335
Practice Address - Country:US
Practice Address - Phone:718-670-1517
Practice Address - Fax:718-539-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04055-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital