Basic Information
| Provider Information | |||||||||
| NPI: | 1053332700 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NYHMCQ-JACKSON HEIGHTS FAMILY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27842 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100877842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186701651 | ||||||||
| FaxNumber: | 5164374167 | ||||||||
| Practice Location | |||||||||
| Address1: | 7315 NORTHERN BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSON HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113721144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184242788 | ||||||||
| FaxNumber: | 5164374167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHIFF | ||||||||
| AuthorizedOfficialFirstName: | MILLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PHYSICIAN BILLING | ||||||||
| AuthorizedOfficialTelephone: | 7186701651 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207V00000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207Y00000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | 208000000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 363LF0000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 01872242 | 05 | NY | MEDICAID |