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General NPI Number Information
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NPI Number | 1497131403
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Entity Type | Organization
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Legal Business Name | ONSITE MEDICAL SUITE PC
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Dates
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Enumeration Date | 08/03/2015
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 9811 QUEENS BLVD SUITE LL3
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City | REGO PARK
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State | NY
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Zip | 11374
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Country | US
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Telephone | 718-606-2800
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Fax | 718-606-2895
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Provider Business Mailing Address
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Address Line | 9811 QUEENS BLVD SUITE LL3
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City | REGO PARK
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State | NY
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Zip | 11374-3338
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Country | US
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Telephone | 718-606-2800
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Fax | 718-606-2895
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DR. MAYYA MUNAROVA
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Credential | DO
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Telephone | 718-606-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 231069
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License Number State | NY
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