Basic Information
| Provider Information | |||||||||
| NPI: | 1144639642 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BNL MEDICAL OFFICE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13939 35TH AVE | ||||||||
| Address2: | CBF | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113543500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188868180 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13939 35TH AVE | ||||||||
| Address2: | CBF | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113543500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188868180 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2014 | ||||||||
| LastUpdateDate: | 08/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | ZHU | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7188868180 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | N | Managed Care Organizations | Exclusive Provider Organization | 302R00000X | N | Managed Care Organizations | Health Maintenance Organization | 305S00000X | N | Managed Care Organizations | Point of Service | 305R00000X | Y | Managed Care Organizations | Preferred Provider Organization |
No ID Information.