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General NPI Number Information
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NPI Number | 1801078894
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Entity Type | Organization
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Legal Business Name | COMMUNITY RELATED SERVICES
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 9907 QUEENS BLVD 2ND FLOOR
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City | REGO PARK
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State | NY
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Zip | 11374-4512
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Country | US
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Telephone | 718-997-1901
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Fax | 718-997-9259
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Provider Business Mailing Address
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Address Line | 99-07 QUEENS BLVD 2ND FLOOR
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City | REGO PARK
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State | NY
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Zip | 11374
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Country | US
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Telephone | 718-997-1901
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Fax | 718-997-9259
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MRS. YELENA MAMEDOVA-BRAZ
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Credential | M.D.
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Telephone | 718-997-1901
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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 |
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License Number State | NY
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