NPI Code Detail JSON Logo

1790663300 NPI number — QUEENS NP IN ADULT HEALTH AND NP IN FAMILY HEALTH PLLC

NPI Number: 1790663300
Health Care Provider/Practitioner: QUEENS NP IN ADULT HEALTH AND NP IN FAMILY HEALTH PLLC

Information about “1790663300” NPI (QUEENS NP IN ADULT HEALTH AND NP IN FAMILY HEALTH PLLC) exists in 1790663300 in HTML format HTML  |  1790663300 in plain Text format TXT  |  1790663300 in PDF (Portable Document Format) PDF  |  1790663300 in an XML format XML  formats.

NPI Number : 1790663300 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790663300",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "QUEENS NP IN ADULT HEALTH AND NP IN FAMILY HEALTH PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6519 BORDEN AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MASPETH",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11378-1630",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "718-255-3346",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6333 98TH PL APT 8Q",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "REGO PARK",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11374-2322",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "347-653-4872",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/22/2025",
    "LastUpdateDate": "08/25/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SHIMONOV",
    "AuthorizedOfficialFirstName": "YURI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "NP",
    "AuthorizedOfficialTelephoneNumber": "718-255-3346",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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