| Acqc | |
|
16121 Jamaica Ave Fl 6 Jamaica NY 11432-6113 | |
| (718) 896-2500 | |
| (718) 459-6542 |
| Full Name | Acqc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 16121 Jamaica Ave Fl 6, Jamaica, New York |
| Authorized Official Name and Position | Mitchel Eisenberg (ASSOCIATE EXECUTIVE DIRECTOR, ADMIN) |
| Authorized Official Contact | 7188962500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Acqc 16121 Jamaica Ave Fl 6 Jamaica NY 11432-6113 Ph: (718) 896-2500 | Acqc 16121 Jamaica Ave Fl 6 Jamaica NY 11432-6113 Ph: (718) 896-2500 |
| NPI Number | 1629274972 |
|---|---|
| Provider Enumeration Date | 06/25/2007 |
| Last Update Date | 10/19/2021 |
| Certification Date | 10/19/2021 |
| Medicare PECOS PAC ID | 4183659790 |
|---|---|
| Medicare Enrollment ID | O20051003000652 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629274972 | NPI | - | NPPES |
| 01225456 | Medicaid | NY | |
| 01551555 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 8219110A (New York) | Primary |
| Provider Name | Kausar Shamim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053404749 PECOS PAC ID: 1850399429 Enrollment ID: I20061114000328 |
| Provider Name | Lawrence Bryskin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184718405 PECOS PAC ID: 5294850194 Enrollment ID: I20100915001105 |
| Provider Name | Laura Anhalt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245487826 PECOS PAC ID: 2466628359 Enrollment ID: I20111227000019 |
| Provider Name | Shabnamzehra Bhojani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366706996 PECOS PAC ID: 3476795881 Enrollment ID: I20130815000004 |
| Provider Name | Robert A Hamilton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326405580 PECOS PAC ID: 8426312166 Enrollment ID: I20180507000097 |
| Provider Name | Nadia V Cheddie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831521384 PECOS PAC ID: 3072842889 Enrollment ID: I20190904000744 |
| Provider Name | Ryan L Doyle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235677485 PECOS PAC ID: 1456776194 Enrollment ID: I20200729000810 |
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