Basic Information
| Provider Information | |||||||||
| NPI: | 1992856769 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMAICA HOSPITAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4153 57TH ST | ||||||||
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| City: | WOODSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113774745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9174767781 | ||||||||
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| Practice Location | |||||||||
| Address1: | 171-23 111TH AVE. | ||||||||
| Address2: | |||||||||
| City: | ST. ALBANS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182069888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | EPSTEIN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | DDS | ||||||||
| AuthorizedOfficialTelephone: | 7187399662 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | 049290 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.