Healthcare Provider Details

I. General information

NPI: 1932459005
Provider Name (Legal Business Name): ON-SITE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29-28 DITMARS BOULEVARD
ASTORIA NY
11105-2731
US

IV. Provider business mailing address

162-15 HIGHLAND AVENUE SUITE 1A
JAMAICA NY
11432
US

V. Phone/Fax

Practice location:
  • Phone: 718-907-1091
  • Fax:
Mailing address:
  • Phone: 718-907-1091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJEEV D SRIVASTAVA
Title or Position: OWNER
Credential: MD
Phone: 718-907-1091