Healthcare Provider Details

I. General information

NPI: 1093759326
Provider Name (Legal Business Name): KEW GARDENS FAMILY PHYSICIANS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11940 METROPOLITAN AVE SUITE E1
KEW GARDENS NY
11415-2600
US

IV. Provider business mailing address

11940 METROPOLITAN AVE SUITE E1
KEW GARDENS NY
11415-2600
US

V. Phone/Fax

Practice location:
  • Phone: 718-849-0624
  • Fax: 718-849-4935
Mailing address:
  • Phone: 718-849-0624
  • Fax: 718-849-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number172844, 171010
License Number StateNY

VIII. Authorized Official

Name: MS. KIM PAROLISI
Title or Position: MEDICAL BILLER
Credential:
Phone: 718-849-0624