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General NPI Number Information
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NPI Number | 1992825772
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Entity Type | Organization
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Legal Business Name | QUEENS MEDICAL LABORATORY
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 43 MINEOLA AVE
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577-1033
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Country | US
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Telephone | 516-626-4101
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Fax | 516-626-4104
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Provider Business Mailing Address
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Address Line | 1300 UNION TPKE STE 204
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1759
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Country | US
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Telephone | 516-626-4101
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Fax | 516-626-4104
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MR. NATHANIEL DWORKIN
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Credential |
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Telephone | 516-626-4101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 3358
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License Number State | NY
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