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General NPI Number Information
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NPI Number | 1609254242
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Entity Type | Organization
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Legal Business Name | STAT MEDICAL SERVICES OF NY PLLC
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 13617 39TH AVE STE 1A
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City | FLUSHING
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State | NY
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Zip | 11354-5504
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Country | US
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Telephone | 718-888-1808
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Fax | 833-888-1808
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Provider Business Mailing Address
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Address Line | 13617 39TH AVE STE 1A
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City | FLUSHING
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State | NY
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Zip | 11354-5504
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Country | US
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Telephone | 718-888-1808
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Fax | 833-888-1808
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACKSON H KUAN
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Credential | M.D.
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Telephone | 718-358-3535
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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 | 1841395100
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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