MEDICARE: ST JOHN'S MEDICAL SERVICES PC

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	207R00000X	Internal Medicine Physician

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

General Provider Information

NPI Number	:	1023042173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JOHN'S MEDICAL SERVICES PC

Provider Business Mailing Address
First Line	:	PO BOX 1388
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11690-1388
Country	:	US
Telephone Number	:	718-869-7641
Fax Number	:	718-869-8507

Provider Business Practice Location Address
First Line	:	327 BEACH 19TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4423
Country	:	US
Telephone Number	:	718-869-7641
Fax Number	:	718-869-8507

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MRS. KATHLEEN E GARCIA
Credential	:
Telephone Number	:	718-869-7641

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/13/2026

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Directions to “ST JOHN'S MEDICAL SERVICES PC ” Practice Location

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