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General NPI Number Information
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NPI Number | 1962844050
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Entity Type | Organization
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Legal Business Name | QUEENS WTC HEALTH PROGRAM
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Dates
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Enumeration Date | 07/18/2013
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | 9777 QUEENS BLVD FL 9
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City | REGO PARK
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State | NY
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Zip | 11374-3335
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Country | US
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Telephone | 718-267-2420
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Fax |
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Provider Business Mailing Address
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Address Line | 9777 QUEENS BLVD FL 9
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City | REGO PARK
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State | NY
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Zip | 11374-3335
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | EDITH SEGOVIA
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Credential |
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Telephone | 718-267-2420
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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 | 081917
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License Number State | NY
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