Provider Demographics
NPI:1184138091
Name:QUEENS PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC
Entity type:Organization
Organization Name:QUEENS PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-593-8460
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0032
Mailing Address - Country:US
Mailing Address - Phone:718-301-1100
Mailing Address - Fax:224-235-4652
Practice Address - Street 1:11602 QUEENS BLVD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7055
Practice Address - Country:US
Practice Address - Phone:718-301-1100
Practice Address - Fax:224-235-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty