MEDICARE: AIDS CENTER OF QUEENS COUNTY, 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	251S00000X	Community/Behavioral Health Agency	8219110A	NY

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

General Provider Information

NPI Number	:	1629274972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIDS CENTER OF QUEENS COUNTY, INC.

Provider Business Mailing Address
First Line	:	16121 JAMAICA AVE FL 6
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-6113
Country	:	US
Telephone Number	:	718-896-2500
Fax Number	:	718-459-6542

Provider Business Practice Location Address
First Line	:	16121 JAMAICA AVE FL 6
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-6113
Country	:	US
Telephone Number	:	718-896-2500
Fax Number	:	718-459-6542

Authorized Official
Title or Position	:	ASSOCIATE EXECUTIVE DIRECTOR, ADMIN
Name	:	MR. MITCHEL EISENBERG
Credential	:
Telephone Number	:	718-896-2500

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	10/19/2021

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