| Fresh Meadows Physician Practice Pllc | |
|
9131 175th St Jamaica NY 11432-5517 | |
| (718) 709-0940 | |
| Not Available |
| Full Name | Fresh Meadows Physician Practice Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 9131 175th St, Jamaica, New York |
| Authorized Official Name and Position | Peyman E Younesi (OWNER) |
| Authorized Official Contact | 7187080940 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fresh Meadows Physician Practice Pllc 6136 170th St Apt M4 Fresh Meadows NY 11365-1957 Ph: (718) 709-0940 | Fresh Meadows Physician Practice Pllc 9131 175th St Jamaica NY 11432-5517 Ph: (718) 709-0940 |
| NPI Number | 1720775083 |
|---|---|
| Provider Enumeration Date | 04/18/2023 |
| Last Update Date | 04/18/2023 |
| Medicare PECOS PAC ID | 0941657811 |
|---|---|
| Medicare Enrollment ID | O20231114003265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720775083 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Peyman Younesi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891942645 PECOS PAC ID: 0345420790 Enrollment ID: I20110202000565 |
| Provider Name | Ryanna D Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285112441 PECOS PAC ID: 3274878301 Enrollment ID: I20181218003386 |
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