Basic Information
| Provider Information | |||||||||
| NPI: | 1871908376 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL QUALIFIED SERVICE OF SUFFOLK COUNTY NEW YORK PLLC | ||||||||
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| OtherOrganizationName: | QSS NEW YORK MEDICAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4059 | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074744059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738268080 | ||||||||
| FaxNumber: | 8663093354 | ||||||||
| Practice Location | |||||||||
| Address1: | 404 POTTER BLVD | ||||||||
| Address2: | |||||||||
| City: | BRIGHTWATERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117181830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738268080 | ||||||||
| FaxNumber: | 8663093354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2014 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | SCHWARTZ | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9738941263 | ||||||||
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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 | 208600000X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.