# QUEENS WTC HEALTH PROGRAM

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NORTH SHORE LONG ISLAND JEWISH
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1962844050
- **Legal business name:** NORTH SHORE LONG ISLAND JEWISH
- **Authorized official:** EDITH SEGOVIA (SOCIAL WORKER)
- **Authorized official phone:** (718) 267-2420

## Contact information

- **Practice address:** 9777 QUEENS BLVD FL 9, REGO PARK, NY 11374-3335
- **Practice address phone:** (718) 267-2420
- **Mailing address:** 9777 QUEENS BLVD FL 9, REGO PARK, NY 11374-3335

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0100X | Occupational Medicine Clinic/Center | 081917 | NY | Yes |

## Other

- **Enumeration date:** 07/18/2013
- **Last updated:** 07/18/2013