Provider Demographics
NPI:1245347301
Name:EZ MEDHEALTH CARE PC
Entity type:Organization
Organization Name:EZ MEDHEALTH CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVYDOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-730-0100
Mailing Address - Street 1:101- 20 QUEENS BLVD
Mailing Address - Street 2:EZ MEDHEALTH CARE PC
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-730-0100
Mailing Address - Fax:718-730-9439
Practice Address - Street 1:101-20 QUEENS BLVD
Practice Address - Street 2:EZ MEDHEALTH CARE PC
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-730-0100
Practice Address - Fax:718-730-9439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02632364Medicaid
06743Medicare ID - Type Unspecified