96TH STREET JUNCTION BLVD MEDICAL PC

NPI 1588157788 Active Family Medicine

Quick Facts

NPI Number

1588157788

Type

Organization (NPI-2)

Status

Active

Enumeration Date

2018-06-12

Last Updated (NPPES)

2018-08-13

Primary Specialty / Taxonomy

Taxonomy	Family Medicine
Taxonomy Code	`207Q00000X`

Practice Address

5548 96TH ST
CORONA, NY 11368

Phone: 718-606-1199

Mailing Address

5548 96TH ST
CORONA, NY 113683009

Data sourced live from the CMS NPPES NPI Registry (npiregistry.cms.hhs.gov) and cached locally. This is a public directory lookup, not a credentialing or verification service — confirm critical details directly with NPPES or the provider.