Queens - Ny Medical, P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

199887 Issued in NY

Legal business name

QUEENS - NY MEDICAL, P.C.

Practice address

4004 Bowne St
Suite 1I
Flushing, NY 11354-6143

Phone

(718) 539-3359

Fax

(718) 358-3837

NPI assigned

Mar 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ida Bronfman, M.D.NPI 1396826814

Title

President

Phone

(718) 539-3359

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ida Bronfman, M.D.

  • Internal Medicine Physician
  • Flushing, NY
  • NPI 1396826814
  Medicare reassignment NPD Authorized official
• Anna Park, NP

  • Adult Health Nurse Practitioner
  • Flushing, NY
  • NPI 1083260095
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189728000000",
    "number": "1316077068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4004 BOWNE ST",
            "address_2": "SUITE 1I",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113546143",
            "telephone_number": "718-539-3359",
            "fax_number": "718-358-3837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 BOWNE ST",
            "address_2": "SUITE 1I",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113546143",
            "telephone_number": "718-539-3359",
            "fax_number": "718-358-3837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEENS - NY MEDICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2007-09-14",
        "status": "A",
        "authorized_official_last_name": "BRONFMAN",
        "authorized_official_first_name": "IDA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-539-3359",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "199887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02517393",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01580827",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Flushing, NY
• Providers in Flushing, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.