Healthcare Provider Details

I. General information

NPI: 1225416837
Provider Name (Legal Business Name): GOOD NEIGHBOR FAMILY PRACTICE AND GERIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13338 41ST RD STE CO-3
FLUSHING NY
11355-3782
US

IV. Provider business mailing address

13338 41ST RD STE CO-3
FLUSHING NY
11355-3782
US

V. Phone/Fax

Practice location:
  • Phone: 718-359-8829
  • Fax: 718-359-8827
Mailing address:
  • Phone: 718-359-8829
  • Fax: 718-359-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number225366
License Number StateNY

VIII. Authorized Official

Name: YI NGAI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-359-8829