Provider Demographics
NPI:1649337890
Name:CORNELL MEDICAL, PC
Entity type:Organization
Organization Name:CORNELL MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-961-8817
Mailing Address - Street 1:13618 39TH AVE
Mailing Address - Street 2:SUITE 906
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5516
Mailing Address - Country:US
Mailing Address - Phone:718-961-8817
Mailing Address - Fax:718-961-8815
Practice Address - Street 1:13618 39TH AVE
Practice Address - Street 2:SUITE 906
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5516
Practice Address - Country:US
Practice Address - Phone:718-961-8817
Practice Address - Fax:718-961-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001367171100000X
NY130031207R00000X
NY1677902084N0400X, 246ZE0500X, 246ZE0600X
NY022580225100000X
NY107344-12471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Multi-Specialty
Not Answered246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty