Provider Demographics
NPI:1396955878
Name:PEDIATRICS FOR QUEENS & KINGS
Entity type:Organization
Organization Name:PEDIATRICS FOR QUEENS & KINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-334-6716
Mailing Address - Street 1:93-20A ROOSEVELT AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-8012
Mailing Address - Country:US
Mailing Address - Phone:718-334-6716
Mailing Address - Fax:
Practice Address - Street 1:9542 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-8012
Practice Address - Country:US
Practice Address - Phone:718-334-6720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care