MEDICARE: HOLLIS HILLS MEDICAL 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	2084P0804X	Child & Adolescent Psychiatry Physician	222374	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1538256268	OTHER	NY	NPI

General Provider Information

NPI Number	:	1750566584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLIS HILLS MEDICAL PC

Provider Business Mailing Address
First Line	:	21715 PECK AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1117
Country	:	US
Telephone Number	:	718-217-2705
Fax Number	:	718-217-2708

Provider Business Practice Location Address
First Line	:	21715 PECK AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1117
Country	:	US
Telephone Number	:	718-217-2705
Fax Number	:	718-217-2708

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR
Name	:	DR. ROXANA RUIZCARO-CHAVEZ
Credential	:	MD
Telephone Number	:	718-217-2705

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	12/28/2007

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Directions to “HOLLIS HILLS MEDICAL PC ” Practice Location

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