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General NPI Number Information
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NPI Number | 1760789879
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Entity Type | Organization
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Legal Business Name | Q A MEDICAL PC
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 3057 CONEY ISLAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11235-6320
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Country | US
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Telephone | 718-934-0300
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Fax | 718-891-7542
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Provider Business Mailing Address
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Address Line | 3057 CONEY ISLAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11235-6320
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Country | US
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Telephone | 718-934-0300
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Fax | 718-891-7542
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Authorized Official
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Title or Position | MANAGER
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Name | SVETLANA NEMIROVSKY
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Credential |
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Telephone | 718-934-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 133357-1
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License Number State | NY
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