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NPI Code Detail

MEDICARE: COMMUNITY RELATED SERVICES

MEDICARE: COMMUNITY RELATED SERVICES
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/CenterNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801078894
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY RELATED SERVICES
Provider Business Mailing Address
First Line : 99-07 QUEENS BLVD
Second Line : 2ND FLOOR
City : REGO PARK
State : NY
Zip : 11374
Country : US
Telephone Number : 718-997-1901
Fax Number : 718-997-9259
Provider Business Practice Location Address
First Line : 9907 QUEENS BLVD
Second Line : 2ND FLOOR
City : REGO PARK
State : NY
Zip : 11374-4512
Country : US
Telephone Number : 718-997-1901
Fax Number : 718-997-9259
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : MRS. YELENA MAMEDOVA-BRAZ
Credential : M.D.
Telephone Number : 718-997-1901
Provider Enumeration Date : 11/30/2007
Last Update Date : 11/30/2007

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Directions to “COMMUNITY RELATED SERVICES ” Practice Location

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