MEDICARE: QUEENS NEUROREHABILITATION, 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	261QM2500X	Medical Specialty Clinic/Center	208835	NY

General Provider Information

NPI Number	:	1760624449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEENS NEUROREHABILITATION, PC

Provider Business Mailing Address
First Line	:	8727 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7847
Country	:	US
Telephone Number	:	718-850-1500
Fax Number	:	718-850-4444

Provider Business Practice Location Address
First Line	:	8727 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7847
Country	:	US
Telephone Number	:	718-850-1500
Fax Number	:	718-850-4444

Authorized Official
Title or Position	:	NEUROLOGIST
Name	:	TAUFIQ AZAMY
Credential	:	MD
Telephone Number	:	718-850-1500

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	03/27/2009

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