| Queens - Ny Medical, P.c. | |
|
4004 Bowne St Suite 1i Flushing NY 11354-6143 | |
| (718) 539-3359 | |
| (718) 358-3837 |
| Full Name | Queens - Ny Medical, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 4004 Bowne St, Flushing, New York |
| Authorized Official Name and Position | Ida Bronfman (PRESIDENT) |
| Authorized Official Contact | 7185393359 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Queens - Ny Medical, P.c. 4004 Bowne St Suite 1i Flushing NY 11354-6143 Ph: (718) 539-3359 | Queens - Ny Medical, P.c. 4004 Bowne St Suite 1i Flushing NY 11354-6143 Ph: (718) 539-3359 |
| NPI Number | 1316077068 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 09/14/2007 |
| Medicare PECOS PAC ID | 2466441464 |
|---|---|
| Medicare Enrollment ID | O20040506000807 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316077068 | NPI | - | NPPES |
| 02517393 | Medicaid | NY | |
| 01580827 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 199887 (New York) | Primary |
| Provider Name | Ida Bronfman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396826814 PECOS PAC ID: 4082603097 Enrollment ID: I20040507001321 |
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