Provider Demographics
NPI:1013964170
Name:PEDERSON-KRAG CENTER INC
Entity type:Organization
Organization Name:PEDERSON-KRAG CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE FOR CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-542-4217
Mailing Address - Street 1:142-02 20TH AVENUE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11351
Mailing Address - Country:US
Mailing Address - Phone:718-559-0555
Mailing Address - Fax:718-445-7111
Practice Address - Street 1:55 HORIZON DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4436
Practice Address - Country:US
Practice Address - Phone:631-920-8000
Practice Address - Fax:631-920-8167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00337004Medicaid
NY01819272Medicaid
NY040403001029OtherFIDELIS
NYW02691OtherBLUE CROSS
NY0007155064OtherAETNA
NY02717417Medicaid
NY0007525706OtherAETNA
NY002875OtherBLUE CROSS
NY1042840-8842OtherBEACON HEALTH STRATEGIES
NY11662OtherVYTRA
NY01934014Medicaid
NY3189305OtherGHI
NYANC1285OtherOXFORD
NY0007632069OtherAETNA
NY001728OtherBLUE CROSS
NY038080OtherVALUE OPTIONS
NYDA1829OtherRAILROAD MEDICARE
NY01556532Medicaid
NY0007632069OtherAETNA
NYANC1285OtherOXFORD
NY040403001029OtherFIDELIS
NY02717417Medicaid