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General NPI Number Information
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NPI Number | 1417294406
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Entity Type | Organization
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Legal Business Name | FOREVER MEDICAL PC
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 14031 CHERRY AVE APT 1A
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City | FLUSHING
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State | NY
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Zip | 11355-3168
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Country | US
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Telephone | 718-353-9088
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Fax | 718-353-9087
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Provider Business Mailing Address
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Address Line | 14031 CHERRY AVE APT 1A
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City | FLUSHING
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State | NY
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Zip | 11355-3168
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Country | US
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Telephone | 718-353-9088
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Fax | 718-353-9087
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Authorized Official
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Title or Position | PHYSIATRIST
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Name | DR. NIU NIU
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Credential | M.D.
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Telephone | 718-353-9088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 250671
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License Number State | NY
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