Basic Information
| Provider Information | |||||||||
| NPI: | 1639552268 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW YORK QUEENS MEDICINE AND SURGERY PC | ||||||||
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| OtherOrganizationName: | FRESH MEADOWS DIABETES & ENDOCRINOLOGY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2649 STRANG BLVD STE 304 | ||||||||
| Address2: | |||||||||
| City: | YORKTOWN HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105982938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2679798095 | ||||||||
| FaxNumber: | 6466977865 | ||||||||
| Practice Location | |||||||||
| Address1: | 17415 HORACE HARDING EXPY | ||||||||
| Address2: | |||||||||
| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113651527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187623111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2015 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | RIMAR | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SHAREHOLDER/DIRECTOR/OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7186618711 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.