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General NPI Number Information
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NPI Number | 1497035638
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Entity Type | Organization
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Legal Business Name | WOODSIDE MEDICAL SERVICES PC
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Dates
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Enumeration Date | 08/19/2011
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 31-20 54TH STREET SUITE L2
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City | WOODSIDE
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State | NY
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Zip | 11377-1530
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Country | US
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Telephone | 718-476-5859
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Fax |
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Provider Business Mailing Address
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Address Line | 3120 54TH ST SUITE L2
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City | WOODSIDE
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State | NY
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Zip | 11377-1530
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Country | US
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Telephone | 718-476-5859
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SERBAN I COCIOBA
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Credential | M.D.
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Telephone | 718-476-5859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | NY
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