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General NPI Number Information
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NPI Number | 1417017443
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Entity Type | Organization
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Legal Business Name | FIRST MED IMMEDIATE MEDICAL SERVICES OF QUEENS PC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 21021 NORTHERN BLVD
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City | BAYSIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 718-224-8855
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Fax | 718-631-2544
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Provider Business Mailing Address
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Address Line | 1345 RXR PLZ FL 13
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City | UNIONDALE
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State | NY
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Zip | 11556-1301
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Country | US
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Telephone | 516-453-0435
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Fax | 646-846-3283
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARLENA SIMPSON
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Credential | CPMSM
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Telephone | 516-783-4600
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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