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Organization
NYHMCQ ADULT AMBULATORY SERVICES
Active
Organization
NYHMCQ ADULT AMBULATORY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE MAYER (CREDENTIALING CONSULTANT)
(631) 952-5717
Entity
Organization
Contact information
Practice address
5645 MAIN ST, FLUSHING, NY 11355-5045
(718) 661-8711
Mailing address
PO BOX 27842, NEW YORK, NY 10087-7842
(718) 661-8711
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RI0008X
Hepatology Physician
—
—
207RN0300X
Nephrology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
208800000X
Urology Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01872242
—
NY
Enumeration date
02/21/2006
Last updated
09/11/2025
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