MEDICARE: NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1225765621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

Provider Business Mailing Address
First Line	:	3750 72ND ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6143
Country	:	US
Telephone Number	:	466-615-7800
Fax Number	:	466-615-7890

Provider Business Practice Location Address
First Line	:	3750 72ND ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6143
Country	:	US
Telephone Number	:	212-238-7815
Fax Number	:	212-238-7629

Authorized Official
Title or Position	:	DIRECTOR OF MANAGED CARE
Name	:	LUCHY JACKSON
Credential	:
Telephone Number	:	212-238-7815

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	04/02/2025

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