MEDICARE: QUALITY CARE MEDICAL OF NY, PC

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	111N00000X	Chiropractor	X007152	NY

General Provider Information

NPI Number	:	1407984032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY CARE MEDICAL OF NY, PC

Provider Business Mailing Address
First Line	:	15031 UNION TPKE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-3927
Country	:	US
Telephone Number	:	718-544-1444
Fax Number	:	718-969-1595

Provider Business Practice Location Address
First Line	:	15031 UNION TPKE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-3927
Country	:	US
Telephone Number	:	718-544-1444
Fax Number	:	718-969-1595

Authorized Official
Title or Position	:	MANAGER
Name	:	LANA ZIRKIEV I
Credential	:
Telephone Number	:	718-544-1444

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	04/28/2009

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