Healthcare Provider Details

I. General information

NPI: 1114397007
Provider Name (Legal Business Name): NEWYORK-PRESBYTERIAN/QUEENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

5645 MAIN ST
FLUSHING NY
11355-5045
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1545
  • Fax: 718-670-1316
Mailing address:
  • Phone: 718-670-1545
  • Fax: 718-670-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number033759
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER FERDINAND MELCHERT
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 718-670-1545