Healthcare Provider Details

I. General information

NPI: 1437808219
Provider Name (Legal Business Name): KINGS COUNTY PHYSICIAN SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18606 UNION TPKE
FRESH MEADOWS NY
11366-1734
US

IV. Provider business mailing address

18606 UNION TPKE
FRESH MEADOWS NY
11366-1734
US

V. Phone/Fax

Practice location:
  • Phone: 516-362-6835
  • Fax: 718-790-4833
Mailing address:
  • Phone: 516-362-6835
  • Fax: 718-790-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DANIEL LEVIHAYM
Title or Position: CHAIRMAN OF BOARD
Credential:
Phone: 516-362-6835