Healthcare Provider Details

I. General information

NPI: 1437352119
Provider Name (Legal Business Name): RJZM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110-20 JAMAICA AVE
RICHMOND HILL NY
11418
US

IV. Provider business mailing address

2604 3RD AVE
BRONX NY
10454-1199
US

V. Phone/Fax

Practice location:
  • Phone: 718-850-4644
  • Fax: 718-849-4644
Mailing address:
  • Phone: 718-292-0100
  • Fax: 718-866-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number7000259R
License Number StateNY

VIII. Authorized Official

Name: MRS. EILEEN SLINGSBY
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-292-0100