Healthcare Provider Details

I. General information

NPI: 1376835082
Provider Name (Legal Business Name): SPRING LIFE MEDICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9617 69TH AVE
FOREST HILLS NY
11375-5139
US

IV. Provider business mailing address

PO BOX 640326
OAKLAND GARDENS NY
11364-0326
US

V. Phone/Fax

Practice location:
  • Phone: 347-589-3714
  • Fax: 347-233-2584
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number218153
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number218153
License Number StateNY

VIII. Authorized Official

Name: DR. HLA TUN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 347-589-3714