| Queens Wound & Medical Care Pc | |
|
6535 Queens Blvd Woodside NY 11377-5769 | |
| (718) 426-4562 | |
| (718) 426-4560 |
| Full Name | Queens Wound & Medical Care Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6535 Queens Blvd, Woodside, New York |
| Authorized Official Name and Position | Erie Agustin (OWNER) |
| Authorized Official Contact | 7184264562 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Queens Wound & Medical Care Pc 6535 Queens Blvd Woodside NY 11377-5769 Ph: (718) 426-4562 | Queens Wound & Medical Care Pc 6535 Queens Blvd Woodside NY 11377-5769 Ph: (718) 426-4562 |
| NPI Number | 1144653072 |
|---|---|
| Provider Enumeration Date | 08/14/2013 |
| Last Update Date | 10/19/2018 |
| Medicare PECOS PAC ID | 5294979118 |
|---|---|
| Medicare Enrollment ID | O20130916000518 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144653072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 196473 (New York) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Erie T Agustin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407892144 PECOS PAC ID: 5294639258 Enrollment ID: I20040726001151 |
| Provider Name | Leonora Monroe |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1962672857 PECOS PAC ID: 8527061555 Enrollment ID: I20060814000092 |
| Provider Name | Glenn J Donovan |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1700950839 PECOS PAC ID: 2264534403 Enrollment ID: I20070219000696 |
| Provider Name | Trinidad Delacruz Agtarap |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295962041 PECOS PAC ID: 8729328307 Enrollment ID: I20190318001679 |
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