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1013964170

NPI Code Detail

MEDICARE: PEDERSON-KRAG CENTER INC

MEDICARE: PEDERSON-KRAG CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
17	DA1829	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	040403001029	OTHER	NY	FIDELIS
4	W02691	OTHER	NY	BLUE CROSS
5	0007155064	OTHER	NY	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	0007525706	OTHER	NY	AETNA
8	002875	OTHER	NY	BLUE CROSS
9	1042840-8842	OTHER	NY	BEACON HEALTH STRATEGIES
10	11662	OTHER	NY	VYTRA
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	3189305	OTHER	NY	GHI
13	ANC1285	OTHER	NY	OXFORD
14	0007632069	OTHER	NY	AETNA
15	001728	OTHER	NY	BLUE CROSS
16	038080	OTHER	NY	VALUE OPTIONS
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013964170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDERSON-KRAG CENTER INC

Provider Business Mailing Address
First Line	:	142-02 20TH AVENUE
Second Line	:	3RD FLOOR
City	:	FLUSHING
State	:	NY
Zip	:	11351
Country	:	US
Telephone Number	:	718-559-0555
Fax Number	:	718-445-7111

Provider Business Practice Location Address
First Line	:	55 HORIZON DR
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-4436
Country	:	US
Telephone Number	:	631-920-8000
Fax Number	:	631-920-8167

Authorized Official
Title or Position	:	VP OF FINANCE FOR CLINICAL SERVICES
Name	:	MS. JACQUELINE RIVERA-HERRERA
Credential	:
Telephone Number	:	347-542-4217

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	03/03/2015

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Directions to “PEDERSON-KRAG CENTER INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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