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General NPI Number Information
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NPI Number | 1871804062
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Entity Type | Organization
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Legal Business Name | JFK ADVANCED MEDICAL PC
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | JFK AIRPORT BUILDING 75 SUITE 247/249
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City | JAMAICA
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State | NY
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Zip | 11430
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Country | US
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Telephone | 718-656-9500
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Fax | 718-656-9503
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Provider Business Mailing Address
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Address Line | JFK AIRPORT BUILDING 75 SUITE 247/249
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City | JAMAICA
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State | NY
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Zip | 11430
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Country | US
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Telephone | 718-656-9500
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Fax | 718-656-9503
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Authorized Official
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Title or Position | MANAGER
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Name | DAVID ROSENTHAL
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Credential |
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Telephone | 718-656-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 174494-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 212722
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License Number State | NY
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