Organization
PEDERSON KRAG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALIK R. DEAN (CREDENTIALING MANAGER)
(718) 559-0555
Entity
Organization
Contact information
Practice address
142-02 20TH AVENUE, FLUSHING, NY 11351
(718) 559-0555
Mailing address
142-02 20TH AVENUE, FLUSHING, NY 11351
(718) 559-0555
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
089076
NY
Other
Enumeration date
10/19/2015
Last updated
10/19/2015
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