Healthcare Provider Details

I. General information

NPI: 1487745816
Provider Name (Legal Business Name): QUEENS MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 93RD ST SUITE 1W
JACKSON HEIGHTS NY
11372-1941
US

IV. Provider business mailing address

3304 93RD ST SUITE 1W
JACKSON HEIGHTS NY
11372-1941
US

V. Phone/Fax

Practice location:
  • Phone: 718-335-4747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AJAY K LODHA
Title or Position: MANAGER
Credential: MD
Phone: 718-335-4747