Healthcare Provider Details

I. General information

NPI: 1417017443
Provider Name (Legal Business Name): FIRST MED IMMEDIATE MEDICAL SERVICES OF QUEENS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21021 NORTHERN BLVD
BAYSIDE NY
11361
US

IV. Provider business mailing address

1345 RXR PLZ FL 13
UNIONDALE NY
11556-1301
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-8855
  • Fax: 718-631-2544
Mailing address:
  • Phone: 516-453-0435
  • Fax: 646-846-3283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARLENA SIMPSON
Title or Position: DIRECTOR
Credential: CPMSM
Phone: 516-783-4600