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General NPI Number Information
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NPI Number | 1871795146
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Entity Type | Organization
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Legal Business Name | QUEENS GENERAL MEDICAL PC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 11203 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1813
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Country | US
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Telephone | 718-641-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 11203 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1813
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Country | US
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Telephone | 718-641-1212
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUJIT BHATTACHARYA
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Credential | MD
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Telephone | 718-641-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X008237
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 219436
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License Number State | NY
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