MEDICARE: NYC MEDICAL OF QUEENS 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

General Provider Information

NPI Number	:	1144854811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYC MEDICAL OF QUEENS PC

Provider Business Mailing Address
First Line	:	7916 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6748
Country	:	US
Telephone Number	:	718-406-9111
Fax Number	:	718-406-9994

Provider Business Practice Location Address
First Line	:	7916 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6748
Country	:	US
Telephone Number	:	718-406-9111
Fax Number	:	718-406-9994

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE ENRIQUE ORTIZ
Credential	:	MD
Telephone Number	:	718-406-9111

Provider Enumeration Date	:	03/02/2020
Last Update Date	:	03/02/2020

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