Basic Information
Provider Information
NPI: 1417349507
EntityType: 2
ReplacementNPI:  
OrganizationName: METRO URGENT MEDICAL CARE OF QUEENS
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 484 TEMPLE HILL RD
Address2: SUITE 104
City: NEW WINDSOR
State: NY
PostalCode: 125535557
CountryCode: US
TelephoneNumber: 8455653700
FaxNumber: 8455653395
Practice Location
Address1: 14-140 JFK TENANT 4
Address2: BLDG 125, JFK AIRPORT
City: JAMAICA
State: NY
PostalCode: 11430
CountryCode: US
TelephoneNumber: 8455653700
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/26/2015
LastUpdateDate: 02/26/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RUVO
AuthorizedOfficialFirstName: ANTHONY
AuthorizedOfficialMiddleName: R.
AuthorizedOfficialTitleorPosition: MEMBER
AuthorizedOfficialTelephone: 8455653700
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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