| 189-04 Facility Inc | |
|
18904 Union Tpke Suite B Fresh Meadows NY 11366-1862 | |
| (718) 271-1414 | |
| Not Available |
| Full Name | 189-04 Facility Inc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 18904 Union Tpke, Fresh Meadows, New York |
| Authorized Official Name and Position | Allen Antonelli (PRESIDENT) |
| Authorized Official Contact | 7182171414 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 189-04 Facility Inc 18904 Union Tpke Suite B Fresh Meadows NY 11366-1862 Ph: (718) 271-1414 | 189-04 Facility Inc 18904 Union Tpke Suite B Fresh Meadows NY 11366-1862 Ph: (718) 271-1414 |
| NPI Number | 1538567730 |
|---|---|
| Provider Enumeration Date | 12/21/2014 |
| Last Update Date | 12/21/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538567730 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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