Provider Demographics
NPI:1861855397
Name:QUEENSMEDICALPC
Entity Type:Organization
Organization Name:QUEENSMEDICALPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:ALFONSO
Authorized Official - Last Name:OLAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-331-4511
Mailing Address - Street 1:3703 82ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7031
Mailing Address - Country:US
Mailing Address - Phone:347-848-1966
Mailing Address - Fax:
Practice Address - Street 1:3703 82ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7031
Practice Address - Country:US
Practice Address - Phone:347-848-1966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240621261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care