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NPI Code Detail

MEDICARE: QLIMG LAKE SUCCESS/NEW HYDE PARK MED. OFFICE

MEDICARE: QLIMG LAKE SUCCESS/NEW HYDE PARK MED. OFFICE
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
1207Q00000XFamily Medicine Physician
2207V00000XObstetrics & Gynecology Physician
3208000000XPediatrics Physician
42080P0201XPediatric Allergy/Immunology Physician
52080P0205XPediatric Endocrinology Physician
6207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1720178486
Entity Type Code : Organization
Provider Name (Legal Business Name) : QLIMG LAKE SUCCESS/NEW HYDE PARK MED. OFFICE
Provider Business Mailing Address
First Line : 1991 MARCUS AVE
Second Line : 2ND FLOOR
City : NEW HYDE PARK
State : NY
Zip : 11042-2057
Country : US
Telephone Number : 516-354-1600
Fax Number : 516-941-4672
Provider Business Practice Location Address
First Line : 1000 ZECKENDORF BLVD
Second Line :
City : GARDEN CITY
State : NY
Zip : 11530-2133
Country : US
Telephone Number : 516-355-5800
Fax Number : 516-355-5877
Authorized Official
Title or Position : DIRECTOR OF CREDENTIALING
Name : MARLENA SIMPSON
Credential : CPMSM
Telephone Number : 516-542-6880
Provider Enumeration Date : 10/13/2006
Last Update Date : 10/22/2010

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Directions to “QLIMG LAKE SUCCESS/NEW HYDE PARK MED. OFFICE ” Practice Location

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