Healthcare Provider Details

I. General information

NPI: 1427668318
Provider Name (Legal Business Name): JACKSON HEIGHTS ALLERGY& ASTHMA,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9317 ROOSEVELT AVE FL 2
JACKSON HEIGHTS NY
11372-7943
US

IV. Provider business mailing address

9317 ROOSEVELT AVE FL 2
JACKSON HEIGHTS NY
11372-7943
US

V. Phone/Fax

Practice location:
  • Phone: 718-899-9009
  • Fax: 718-899-9002
Mailing address:
  • Phone: 718-899-9009
  • Fax: 718-899-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STANLEY GOLDSTEIN
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 718-899-9009