Basic Information
| Provider Information | |||||||||
| NPI: | 1497119846 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEENS PSYCHIATRIC & MEDICAL CARE P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9520 63RD RD | ||||||||
| Address2: | SUITE J | ||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113741160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184591225 | ||||||||
| FaxNumber: | 7184595805 | ||||||||
| Practice Location | |||||||||
| Address1: | 9520 63RD RD | ||||||||
| Address2: | SUITE J | ||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113741160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184591225 | ||||||||
| FaxNumber: | 7184595805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2016 | ||||||||
| LastUpdateDate: | 04/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | TAM | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7184591225 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.