=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407090228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A1 MEDICINE P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2009
-----------------------------------------------------
Last Update Date | 04/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9545 ROOSEVELT AVE
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-8028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-565-7500
-----------------------------------------------------
Fax | 718-396-4091
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9545 ROOSEVELT AVE
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-8028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-565-7500
-----------------------------------------------------
Fax | 718-396-4091
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. ROBERT F HOSTY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-565-7500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 414667
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------