| South Jamaica Clinic | |
|
11515 Sutphin Blvd Jamaica NY 11434-1020 | |
| (718) 659-4000 | |
| (718) 659-1405 |
| Full Name | South Jamaica Clinic |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 11515 Sutphin Blvd, Jamaica, New York |
| Authorized Official Name and Position | Jean M Coppola (DIRECTOR OF BILLING) |
| Authorized Official Contact | 7186517770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Jamaica Clinic 6002 Queens Blvd Lower Level Woodside NY 11377-4973 Ph: (718) 651-7770 | South Jamaica Clinic 11515 Sutphin Blvd Jamaica NY 11434-1020 Ph: (718) 659-4000 |
| NPI Number | 1235288333 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 12/19/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235288333 | NPI | - | NPPES |
| 00244371 | Medicaid | NY | |
| 7403085 | Other | NY | GHI |
| WV0071 | Other | NY | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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