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General NPI Number Information
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NPI Number | 1598925604
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Entity Type | Organization
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Legal Business Name | QUEENS PEDIATRIC SERVICES, P.C.
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 1847 MOTT AVE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-4201
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Country | US
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Telephone | 718-868-8282
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Fax | 718-471-2865
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Provider Business Mailing Address
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Address Line | 1847 MOTT AVE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-4201
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Country | US
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Telephone | 718-868-8282
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Fax | 718-471-2865
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUTFA KHANAM
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Credential | M.D.
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Telephone | 718-868-8282
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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 |
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License Number State |
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