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General NPI Number Information
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NPI Number | 1659813962
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Entity Type | Organization
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Legal Business Name | MEADOW MEDICAL SERVICES, PC
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 25 CENTRAL PARK W
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City | NEW YORK
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State | NY
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Zip | 10023-7253
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Country | US
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Telephone | 718-354-6810
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Fax |
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Provider Business Mailing Address
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Address Line | 565 CONWAY RD
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City | ELMONT
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State | NY
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Zip | 11003-3519
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | EVANS CREVECOEUR
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Credential | M.D.
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Telephone | 718-354-6810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3272
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License Number State | NY
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