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Organization
PREMIUM MEDICAL OF NEW YORK PC
Active
Organization
PREMIUM MEDICAL OF NEW YORK PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER GEORGIOU (SOLE PROPRIETER)
(718) 463-2630
Entity
Organization
Contact information
Practice address
147-09 ELM AVE, FLUSHING, NY 11355
(718) 463-2630
Mailing address
147-09 ELM AVE, FLUSHING, NY 11355
(718) 463-2630
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
1937884
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01685730
—
NY
Enumeration date
11/22/2006
Last updated
08/22/2020
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