Healthcare Provider Details

I. General information

NPI: 1225683840
Provider Name (Legal Business Name): MEDICAL CARE OF QUEENS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17660 UNION TPKE STE 360
FRESH MEADOWS NY
11366-1531
US

IV. Provider business mailing address

17660 UNION TPKE STE 360
FRESH MEADOWS NY
11366-1531
US

V. Phone/Fax

Practice location:
  • Phone: 718-460-2300
  • Fax: 347-225-9930
Mailing address:
  • Phone: 718-460-2300
  • Fax: 347-225-9930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MICHELE L CUSACK
Title or Position: SENIOR VICE PRESIDENT & CFO
Credential:
Phone: 516-321-6058