Healthcare Provider Details

I. General information

NPI: 1689879280
Provider Name (Legal Business Name): HILLSIDE POLYMEDIC DIAGNOSTIC & TREATMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18730 HILLSIDE AVE
JAMAICA NY
11432-3216
US

IV. Provider business mailing address

18730 HILLSIDE AVE
JAMAICA NY
11432-3216
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-1111
  • Fax:
Mailing address:
  • Phone: 718-264-1111
  • Fax: 718-264-9125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: MS. BRIDGET CHIME
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-264-1111