Organization Name:  QUEENS LONG ISLAND MEDICAL GROUP, P.C.


Practice Location:
441 9TH AVE 9TH FLOOR NEW YORK, NY 10001 US
Tel: 646-680-2894  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	207K00000X	Physicians Allergy & Immunology
N	207Q00000X	Physicians Family Medicine
N	207RH0003X	Physicians Internal Medicine
N	207RP1001X	Physicians Internal Medicine
N	207RR0500X	Physicians Internal Medicine
N	207V00000X	Physicians Obstetrics & Gynecology
N	207W00000X	Physicians Ophthalmology
N	207X00000X	Physicians Orthopaedic Surgery
N	208000000X	Physicians Pediatrics
N	2080P0201X	Physicians Pediatrics
N	2080P0205X	Physicians Pediatrics
N	208600000X	Physicians Surgery
N	208800000X	Physicians Urology
N	213E00000X	Podiatric Medicine & Surgery Service Providers Podiatrist
Y	207R00000X	Physicians Internal Medicine

Other Provider Identifiers:

Issuer	Number	State	Type
	04007250	NY	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin