Basic Information
| Provider Information | |||||||||
| NPI: | 1710009709 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW YORK HOSPITAL QUEENS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 COLLINWOOD DR | ||||||||
| Address2: | |||||||||
| City: | BREWSTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105095957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452593717 | ||||||||
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| Practice Location | |||||||||
| Address1: | 56-45 MAIN STREET | ||||||||
| Address2: | OBGYN DEPT. | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186701517 | ||||||||
| FaxNumber: | 7185391669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MANGOME | ||||||||
| AuthorizedOfficialFirstName: | MARLENE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 7186701517 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 04055-1 | NY | Y | Hospitals | General Acute Care Hospital |
No ID Information.