Healthcare Provider Details

I. General information

NPI: 1689914509
Provider Name (Legal Business Name): KEW GARDENS MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8027 135TH ST
JAMAICA NY
11435-1029
US

IV. Provider business mailing address

8027 135TH ST
JAMAICA NY
11435-1029
US

V. Phone/Fax

Practice location:
  • Phone: 347-561-3120
  • Fax: 347-561-3142
Mailing address:
  • Phone: 347-561-3120
  • Fax: 347-561-3142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number177709
License Number StateNY

VIII. Authorized Official

Name: DR. BARRY SLOAN
Title or Position: PRESIDENT
Credential: M.D
Phone: 347-561-3120