Provider Demographics
NPI:1780826610
Name:QUEENS NEPHRON MEDICINE DOCS PLLC
Entity Type:Organization
Organization Name:QUEENS NEPHRON MEDICINE DOCS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LJUBISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-438-1950
Mailing Address - Street 1:2604 169TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2604 169TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1131
Practice Address - Country:US
Practice Address - Phone:347-438-1950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty