Healthcare Provider Details

I. General information

NPI: 1609151950
Provider Name (Legal Business Name): COREHEALTH MEDICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247-39 JAMAICA AVE 2ND FLOOR
QUEENS NY
11426-1541
US

IV. Provider business mailing address

24739 JAMAICA 2ND FLOOR
BELLEROSE NY
11426-1541
US

V. Phone/Fax

Practice location:
  • Phone: 718-343-2045
  • Fax: 718-343-2088
Mailing address:
  • Phone: 718-343-2045
  • Fax: 718-343-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVE CHIKEZIE IDEYI
Title or Position: OWNER
Credential: MD
Phone: 718-343-2045