Healthcare Provider Details

I. General information

NPI: 1609254242
Provider Name (Legal Business Name): STAT MEDICAL SERVICES OF NY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13617 39TH AVE STE 1A
FLUSHING NY
11354-5504
US

IV. Provider business mailing address

13617 39TH AVE STE 1A
FLUSHING NY
11354-5504
US

V. Phone/Fax

Practice location:
  • Phone: 718-888-1808
  • Fax: 833-888-1808
Mailing address:
  • Phone: 718-888-1808
  • Fax: 833-888-1808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1841395100
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACKSON H KUAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-358-3535