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General NPI Number Information
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NPI Number | 1790027985
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Entity Type | Organization
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Legal Business Name | HEALTHLAND MEDICAL CARE PLLC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 43-16 215TH ST
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City | BAYSIDE
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State | NY
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Zip | 11356
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Country | US
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Telephone | 718-224-0120
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Fax |
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Provider Business Mailing Address
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Address Line | 9 YORK DR
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City | GREAT NECK
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State | NY
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Zip | 11021-3921
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Country | US
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Telephone | 347-392-9326
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PEI GAO
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Credential | M.D.
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Telephone | 349-392-9326
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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 | 266380
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License Number State | NY
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