Healthcare Provider Details

I. General information

NPI: 1902281850
Provider Name (Legal Business Name): JAMAICA MEDICAL CENTER NY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9016 SUTPHIN BLVD
JAMAICA NY
11435-3636
US

IV. Provider business mailing address

9016 SUTPHIN BLVD
JAMAICA NY
11435-3636
US

V. Phone/Fax

Practice location:
  • Phone: 718-487-4016
  • Fax: 718-487-3957
Mailing address:
  • Phone: 718-487-4016
  • Fax: 718-487-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELLE KURK
Title or Position: PRESIDENT
Credential: MD
Phone: 718-487-4016