Healthcare Provider Details

I. General information

NPI: 1023011285
Provider Name (Legal Business Name): QUEENS MEDICAL IMAGING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6915 AUSTIN ST
FOREST HILLS NY
11375-4238
US

IV. Provider business mailing address

6915 AUSTIN ST
FOREST HILLS NY
11375-4238
US

V. Phone/Fax

Practice location:
  • Phone: 718-544-5100
  • Fax: 718-575-1926
Mailing address:
  • Phone: 718-544-5100
  • Fax: 718-575-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberH98099818578
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW WINAKOR
Title or Position: DIRECTOR, MANAGED CARE
Credential:
Phone: 516-616-5000