MEDICARE: JACKSON HEIGHTS MEDICAL, P.C.

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	207R00000X	Internal Medicine Physician	186252	NY

General Provider Information

NPI Number	:	1811912595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON HEIGHTS MEDICAL, P.C.

Provider Business Mailing Address
First Line	:	3743 76TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6533
Country	:	US
Telephone Number	:	718-396-0200
Fax Number	:	718-505-2819

Provider Business Practice Location Address
First Line	:	3743 76TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6533
Country	:	US
Telephone Number	:	718-396-0200
Fax Number	:	718-505-2819

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALVIS YEE
Credential	:	M.D.
Telephone Number	:	718-396-0200

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	09/24/2008

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