Organization
PREMIER PET MANAGEMENT OF QUEENS LLC
Active
Other names
forest hills pet imaging pc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUCILLE PATRICIA TAVERNA M.D (MEDICAL DIRECTOR)
(516) 255-9555
Entity
Organization
Contact information
Practice address
10202 QUEENS BLVD, FOREST HILLS, NY 11375-3197
(718) 896-7600
(718) 896-7601
Mailing address
10202 QUEENS BLVD, FOREST HILLS, NY 11375-3197
(718) 896-7600
(718) 896-7601
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
1124741
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00380218
—
NY
Enumeration date
11/24/2006
Last updated
10/10/2007
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