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General NPI Number Information
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NPI Number | 1750566584
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Entity Type | Organization
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Legal Business Name | HOLLIS HILLS MEDICAL PC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 12/28/2007
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Provider Practice Location Address
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Address Line | 21715 PECK AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1117
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Country | US
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Telephone | 718-217-2705
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Fax | 718-217-2708
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Provider Business Mailing Address
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Address Line | 21715 PECK AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1117
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Country | US
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Telephone | 718-217-2705
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Fax | 718-217-2708
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR
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Name | DR. ROXANA RUIZCARO-CHAVEZ
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Credential | MD
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Telephone | 718-217-2705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 222374
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License Number State | NY
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