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General NPI Number Information
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NPI Number | 1003015298
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Entity Type | Organization
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Legal Business Name | QUEENS FAMILY MEDICAL HEALTH AND WELLNESS, PC
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 11120 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-6341
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Country | US
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Telephone | 718-261-7600
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Fax | 718-261-7606
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Provider Business Mailing Address
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Address Line | 11120 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-6341
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Country | US
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Telephone | 718-261-7600
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Fax | 718-261-7606
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HARVEY WIEDER
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Credential | M.D.
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Telephone | 718-261-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 206669
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License Number State | NY
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