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General NPI Number Information
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NPI Number | 1306021290
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Entity Type | Organization
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Legal Business Name | QUEENS HEMATOLOGY ONCOLOGY PC
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 10850 62ND DR SUITE LA
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City | FOREST HILLS
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State | NY
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Zip | 11375-1261
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Country | US
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Telephone | 718-830-6333
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Fax | 718-830-6355
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Provider Business Mailing Address
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Address Line | 10850 62ND DR SUITE LA
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City | FOREST HILLS
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State | NY
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Zip | 11375-1261
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ARAXI GEVORGYAN
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Credential |
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Telephone | 718-830-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 167703
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License Number State | NY
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