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General NPI Number Information
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NPI Number | 1982809836
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Entity Type | Organization
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Legal Business Name | IVY MEDICAL SERVICES PC
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 03/15/2018
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Provider Practice Location Address
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Address Line | 3808 UNION ST APT 3J
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City | FLUSHING
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State | NY
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Zip | 11354-5500
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Country | US
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Telephone | 718-321-3522
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Fax | 718-321-3533
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Provider Business Mailing Address
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Address Line | 15 ROUND HILL RD
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City | GREAT NECK
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State | NY
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Zip | 11020-1212
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Country | US
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Telephone | 718-321-3522
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Fax |
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Authorized Official
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Title or Position | ATTENDING
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Name | DR. QIONG WU I
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Credential | MD
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Telephone | 718-321-3522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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