Healthcare Provider Details

I. General information

NPI: 1861311946
Provider Name (Legal Business Name): MEDENTRA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8921 169TH ST APT 6G
JAMAICA NY
11432-5238
US

IV. Provider business mailing address

22210 93RD RD
QUEENS VILLAGE NY
11428-1936
US

V. Phone/Fax

Practice location:
  • Phone: 346-396-1252
  • Fax:
Mailing address:
  • Phone: 346-396-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: LOVELY AKTER
Title or Position: MANAGING MEMBER
Credential:
Phone: 346-396-1252