Healthcare Provider Details

I. General information

NPI: 1528408366
Provider Name (Legal Business Name): SYOSSET QUALITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MELANIE LN
SYOSSET NY
11791-5831
US

IV. Provider business mailing address

15 MELANIE LN
SYOSSET NY
11791-5831
US

V. Phone/Fax

Practice location:
  • Phone: 516-488-9427
  • Fax: 800-557-3140
Mailing address:
  • Phone: 516-488-9427
  • Fax: 800-557-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEQIN GAO
Title or Position: MEMBER
Credential: MD
Phone: 516-488-9427