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General NPI Number Information
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NPI Number | 1821245705
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Entity Type | Organization
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Legal Business Name | QUEENS ALLERGY & ASTHMA CARE PLLC
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 10915 QUEENS BLVD SUITE 1P
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City | FOREST HILLS
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State | NY
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Zip | 11375-5482
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Country | US
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Telephone | 718-261-2661
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Fax | 718-261-0085
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Provider Business Mailing Address
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Address Line | 10915 QUEENS BLVD SUITE 1P
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City | FOREST HILLS
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State | NY
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Zip | 11375-5482
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Country | US
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Telephone | 718-261-2661
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Fax | 718-261-0085
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LISA BELINDA MORENO
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Credential | M.D.
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Telephone | 718-261-2661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 223927
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License Number State | NY
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