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General NPI Number Information
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NPI Number | 1518307198
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD PRIMARY CARE, PC
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 21814 HILLSIDE AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1951
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Country | US
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Telephone | 718-776-4444
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Fax | 718-776-8536
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Provider Business Mailing Address
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Address Line | 21814 HILLSIDE AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1951
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Country | US
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Telephone | 718-776-4444
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Fax | 718-776-8536
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MAHENDRA RATILAL AMIN
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Credential | M.D.
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Telephone | 718-776-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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