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Organization
SLB MEDICAL ASSOCIATES
Active
Organization
SLB MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEAN-ROBERT BOURSIQUOT MD (MEDICAL DIRECTOR)
(718) 507-5656
Entity
Organization
Contact information
Practice address
3765 104TH ST, CORONA, NY 11368-1947
(718) 507-5656
(718) 507-0884
Mailing address
3765 104TH ST, CORONA, NY 11368-1947
(718) 507-5656
(718) 507-0884
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
156767
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01369497
—
NY
Enumeration date
06/30/2009
Last updated
06/30/2009
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