Basic Information
| Provider Information | |||||||||
| NPI: | 1548778806 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NYC HHC ELMHURST HOSPITAL CENTER | ||||||||
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| Address1: | 5906 146TH ST | ||||||||
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| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113555328 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7901 BROADWAY RM BA-1A | ||||||||
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| City: | ELMHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113731329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183341728 | ||||||||
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| ProviderEnumerationDate: | 01/19/2018 | ||||||||
| LastUpdateDate: | 01/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | ROCHA | ||||||||
| AuthorizedOfficialFirstName: | ISRAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7183341638 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 86080771 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.