Healthcare Provider Details

I. General information

NPI: 1386624617
Provider Name (Legal Business Name): JAMAICA MEDICAL HEIGHTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 17 JAMAICA AVE
QUEENS VILLAGE NY
11428
US

IV. Provider business mailing address

215 17 JAMAICA AVE
QUEENS VILLAGE NY
11428
US

V. Phone/Fax

Practice location:
  • Phone: 718-740-3106
  • Fax: 718-740-3253
Mailing address:
  • Phone: 718-740-3106
  • Fax: 718-740-3253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number191242
License Number StateNY

VIII. Authorized Official

Name: DR. MARCEL BENOIT
Title or Position: SOLE PROPRIETER
Credential: MD
Phone: 718-740-3106