Provider Demographics
NPI:1669699096
Name:JACKSON HEIGHTS MEDICAL, P.C.
Entity type:Organization
Organization Name:JACKSON HEIGHTS MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:YEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-396-0200
Mailing Address - Street 1:3743 76TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6533
Mailing Address - Country:US
Mailing Address - Phone:718-396-0200
Mailing Address - Fax:718-505-2819
Practice Address - Street 1:3743 76TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6533
Practice Address - Country:US
Practice Address - Phone:718-396-0200
Practice Address - Fax:718-505-2819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186252208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07791Medicare PIN