Provider Demographics
NPI: | 1013960962 |
---|---|
Name: | NEWYORK-PRESBYTERIAN/QUEENS |
Entity Type: | Organization |
Organization Name: | NEWYORK-PRESBYTERIAN/QUEENS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ACTING DIRECTOR OF BILLING |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | DORA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HARTOFILIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 718-661-8711 |
Mailing Address - Street 1: | PO BOX 27842 |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10087-7842 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-670-1651 |
Mailing Address - Fax: | 516-437-4167 |
Practice Address - Street 1: | 5645 MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | FLUSHING |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11355-5045 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-886-7014 |
Practice Address - Fax: | 516-437-4167 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | NEWYORK-PRESBYTERIAN/QUEENS |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-05-19 |
Last Update Date: | 2015-08-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 02993566 | Medicaid | |
NY | A100001357 | Medicare PIN | |
NY | 02993566 | Medicaid |