Healthcare Provider Details

I. General information

NPI: 1528183480
Provider Name (Legal Business Name): QUEENS ENDOCRINOLOGY PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 ROOSEVELT AVE # A 2ND FL
JACKSON HEIGHTS NY
11372-7904
US

IV. Provider business mailing address

9320 ROOSEVELT AVE # A 2ND FL
JACKSON HEIGHTS NY
11372-7904
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-6712
  • Fax:
Mailing address:
  • Phone: 718-334-6712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. INGRID IVANNA FELIX-PERALTA
Title or Position: CEO
Credential: MD
Phone: 718-334-6712