Provider Demographics
NPI:1538582234
Name:NEW AGE MEDICAL PC
Entity type:Organization
Organization Name:NEW AGE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-263-2208
Mailing Address - Street 1:11120 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6303
Mailing Address - Country:US
Mailing Address - Phone:718-263-2208
Mailing Address - Fax:718-263-3442
Practice Address - Street 1:11120 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6303
Practice Address - Country:US
Practice Address - Phone:718-263-2208
Practice Address - Fax:718-263-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069351261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center