Organization
PROVISION AT NEW YORK LLC
Active
Organization
PROVISION AT NEW YORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMILY Y CHU OD (CEO)
(718) 780-7862
Entity
Organization
Contact information
Practice address
6135 JUNCTION BLVD, REGO PARK, NY 11374-2771
(718) 760-7862
(718) 760-7861
Mailing address
7285 YELLOWSTONE BLVD, FOREST HILLS, NY 11375-4133
(718) 760-7862
(718) 760-7861
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
TUV006676
NY
261QP2300X
Primary Care Clinic/Center
TUV006676
NY
Other
Enumeration date
07/07/2011
Last updated
07/31/2012
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