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General NPI Number Information
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NPI Number | 1437305174
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Entity Type | Organization
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Legal Business Name | PRIORITY MEDICAL GROUP, P.C.
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 16402 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11432-4914
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Country | US
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Telephone | 718-206-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 16402 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11432-4914
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Country | US
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Telephone | 718-206-2700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YURY FAYDA
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Credential | M.D.
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Telephone | 718-206-4420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 112714
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 112714
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License Number State | NY
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