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General NPI Number Information
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NPI Number | 1902281850
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Entity Type | Organization
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Legal Business Name | JAMAICA MEDICAL CENTER NY PC
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 9016 SUTPHIN BLVD
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City | JAMAICA
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State | NY
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Zip | 11435-3636
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Country | US
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Telephone | 718-487-4016
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Fax | 718-487-3957
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Provider Business Mailing Address
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Address Line | 9016 SUTPHIN BLVD
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City | JAMAICA
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State | NY
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Zip | 11435-3636
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Country | US
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Telephone | 718-487-4016
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Fax | 718-487-3957
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MITCHELLE KURK
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Credential | MD
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Telephone | 718-487-4016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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