MEDICARE: CORNELL MEDICAL, 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	171100000X	Acupuncturist	001367	NY
2	207R00000X	Internal Medicine Physician	130031	NY
3	2084N0400X	Neurology Physician	167790	NY
4	225100000X	Physical Therapist	022580	NY
5	246ZE0500X	EEG Specialist/Technologist	167790	NY
6	2471C3402X	Radiography Radiologic Technologist	107344-1	NY
7	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	167790	NY

General Provider Information

NPI Number	:	1649337890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNELL MEDICAL, PC

Provider Business Mailing Address
First Line	:	13618 39TH AVE
Second Line	:	SUITE 906
City	:	FLUSHING
State	:	NY
Zip	:	11354-5516
Country	:	US
Telephone Number	:	718-961-8817
Fax Number	:	718-961-8815

Provider Business Practice Location Address
First Line	:	13618 39TH AVE
Second Line	:	SUITE 906
City	:	FLUSHING
State	:	NY
Zip	:	11354-5516
Country	:	US
Telephone Number	:	718-961-8817
Fax Number	:	718-961-8815

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. RAQUEL G KELLY
Credential	:
Telephone Number	:	718-961-8817

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	09/11/2025

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Directions to “CORNELL MEDICAL, PC ” Practice Location

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