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General NPI Number Information
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NPI Number | 1518008648
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Entity Type | Organization
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Legal Business Name | SLB MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 9703 SPRINGFIELD BLVD 1ST FLOOR
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-1328
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Country | US
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Telephone | 718-465-7200
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Fax | 718-465-0407
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Provider Business Mailing Address
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Address Line | 3765 104TH ST 1ST FLOOR
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City | CORONA
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State | NY
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Zip | 11368-1947
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Country | US
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Telephone | 718-507-5656
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Fax | 718-507-0884
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MARIO SAINT-LAURENT
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Credential | M.D.
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Telephone | 718-507-5656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 155418
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License Number State | NY
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