Basic Information
| Provider Information | |||||||||
| NPI: | 1093926347 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW YORK HOSPITAL QUEENS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6745 190TH LN # C | ||||||||
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| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113653754 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5645 MAIN ST | ||||||||
| Address2: | WA 100 | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113555045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186702627 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ADKINS | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN, DEPT. OF CARDIAC SURGERY | ||||||||
| AuthorizedOfficialTelephone: | 7186702627 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 005619 | NY | Y | Hospitals | General Acute Care Hospital |
No ID Information.