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General NPI Number Information
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NPI Number | 1245628262
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Entity Type | Organization
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Legal Business Name | 410 MEDICAL, P.C
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 9050 PARSONS BLVD STE 410
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City | JAMAICA
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State | NY
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Zip | 11432-6052
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Country | US
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Telephone | 212-470-0360
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Fax |
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Provider Business Mailing Address
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Address Line | 9050 PARSONS BLVD STE 410
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City | JAMAICA
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State | NY
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Zip | 11432-6052
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Country | US
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Telephone | 212-470-0360
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN WONG
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Credential | M.D
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Telephone | 212-470-0360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A188292-1
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License Number State | NY
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