Provider Demographics
NPI:1023053527
Name:NEWYORK-PRESBYTERIAN-QUEENS
Entity type:Organization
Organization Name:NEWYORK-PRESBYTERIAN-QUEENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP, CFO AND TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:RF
Authorized Official - Last Name:LANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-746-7905
Mailing Address - Street 1:5928 174TH ST
Mailing Address - Street 2:FRESH MEADOWS
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1539
Mailing Address - Country:US
Mailing Address - Phone:718-670-1276
Mailing Address - Fax:
Practice Address - Street 1:5928 174TH ST
Practice Address - Street 2:FRESH MEADOWS
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1539
Practice Address - Country:US
Practice Address - Phone:718-670-1276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NYP COMMUNITY PROGRAMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003010H PFI 2670261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY333547OtherMEDICARE PTAN
NY00244133Medicaid
NY02998992Medicaid