| Queens Village Primary Medical Care, Pllc | |
|
9204 Springfield Blvd Queens Village NY 11428-1857 | |
| (718) 465-3040 | |
| (718) 464-9063 |
| Full Name | Queens Village Primary Medical Care, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9204 Springfield Blvd, Queens Village, New York |
| Authorized Official Name and Position | Aryel Nicoleau (MEDICAL DOCTOR) |
| Authorized Official Contact | 7184653040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Queens Village Primary Medical Care, Pllc 9204 Springfield Blvd Queens Village NY 11428-1857 Ph: (718) 465-3040 | Queens Village Primary Medical Care, Pllc 9204 Springfield Blvd Queens Village NY 11428-1857 Ph: (718) 465-3040 |
| NPI Number | 1164614590 |
|---|---|
| Provider Enumeration Date | 08/09/2007 |
| Last Update Date | 02/01/2017 |
| Medicare PECOS PAC ID | 2062467137 |
|---|---|
| Medicare Enrollment ID | O20050322000551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164614590 | NPI | - | NPPES |
| 00587146 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 141741 (New York) | Primary |
| Provider Name | Aryel Nicoleau |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093880957 PECOS PAC ID: 5597712703 Enrollment ID: I20050505000820 |
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