Healthcare Provider Details

I. General information

NPI: 1477505220
Provider Name (Legal Business Name): JAMAICA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 VAN WYCK EXPWY
JAMAICA NY
11418-2897
US

IV. Provider business mailing address

80 MARCUS DR PROVIDER ENROLLMENT DEPT.
MELVILLE NY
11747
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-8918
  • Fax: 631-454-4163
Mailing address:
  • Phone: 631-391-7797
  • Fax: 631-454-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MOUNIR F DOSS
Title or Position: EXECUTIVE VP & CFO
Credential: CFO
Phone: 718-240-5773