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NPI Code Detail

MEDICARE: QUEENS HEALTH CENTER

MEDICARE: QUEENS HEALTH CENTER
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
1261Q00000XClinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17002184ROTHERNYLICENSE NUMBER

General Provider Information

NPI Number : 1508224551
Entity Type Code : Organization
Provider Name (Legal Business Name) : QUEENS HEALTH CENTER
Provider Business Mailing Address
First Line : 305 W 44TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10036-5498
Country : US
Telephone Number : 212-586-6400
Fax Number :
Provider Business Practice Location Address
First Line : 3711 QUEENS BLVD
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-1725
Country : US
Telephone Number : 718-606-3863
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : DR. DAVID JACOBSON
Credential : DMD
Telephone Number : 212-586-6400
Provider Enumeration Date : 02/05/2016
Last Update Date : 04/07/2026

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Directions to “QUEENS HEALTH CENTER ” Practice Location

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