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General NPI Number Information
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NPI Number | 1013964170
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Entity Type | Organization
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Legal Business Name | PEDERSON-KRAG CENTER INC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 55 HORIZON DR
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City | HUNTINGTON
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State | NY
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Zip | 11743-4436
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Country | US
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Telephone | 631-920-8000
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Fax | 631-920-8167
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Provider Business Mailing Address
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Address Line | 142-02 20TH AVENUE 3RD FLOOR
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City | FLUSHING
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State | NY
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Zip | 11351
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Country | US
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Telephone | 718-559-0555
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Fax | 718-445-7111
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Authorized Official
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Title or Position | VP OF FINANCE FOR CLINICAL SERVICES
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Name | MS. JACQUELINE RIVERA-HERRERA
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Credential |
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Telephone | 347-542-4217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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