Healthcare Provider Details

I. General information

NPI: 1326250549
Provider Name (Legal Business Name): HEIGHTS PHYSICIANS GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3743 91ST ST
JACKSON HEIGHTS NY
11372-7927
US

IV. Provider business mailing address

3743 91ST ST
JACKSON HEIGHTS NY
11372-7927
US

V. Phone/Fax

Practice location:
  • Phone: 718-565-5554
  • Fax: 718-565-5557
Mailing address:
  • Phone: 718-565-5554
  • Fax: 718-565-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number238007-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number231684-1
License Number StateNY

VIII. Authorized Official

Name: DR. JORGE V ALVARADO RIVERA
Title or Position: OWNER
Credential: M.D.
Phone: 718-565-5554