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General NPI Number Information
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NPI Number | 1902436884
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Entity Type | Organization
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Legal Business Name | QUEENS WELLNESS INC
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Dates
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Enumeration Date | 01/20/2020
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Last Update Date | 01/20/2020
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Provider Practice Location Address
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Address Line | 11905 80TH RD
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City | KEW GARDENS
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State | NY
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Zip | 11415-1105
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Country | US
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Telephone | 718-575-0007
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Fax | 718-575-0027
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Provider Business Mailing Address
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Address Line | 11905 80TH RD
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City | KEW GARDENS
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State | NY
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Zip | 11415-1105
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Country | US
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Telephone | 718-575-0007
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Fax | 718-575-0027
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ALEXANDER VARONA BALDONADO
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Credential | MD
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Telephone | 929-281-9296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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