Healthcare Provider Details

I. General information

NPI: 1164630448
Provider Name (Legal Business Name): QUEENS MEDICAL SERVICES, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 92ND ST
JACKSON HEIGHTS NY
11372-7929
US

IV. Provider business mailing address

3703 92ND ST
JACKSON HEIGHTS NY
11372-7929
US

V. Phone/Fax

Practice location:
  • Phone: 718-505-1300
  • Fax: 718-505-1883
Mailing address:
  • Phone: 718-505-1300
  • Fax: 718-505-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number217513
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number199134
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number202437
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID GUHA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-505-1300