NPIMap

Organization Active NPI

Premium Medical of New York PC

  • Legal Medicine
  • Flushing, NY
National Provider Identifier
1386719557
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
1937884 Issued in NY
Legal business name
PREMIUM MEDICAL OF NEW YORK PC
Practice address
147-09 Elm Ave
Flushing, NY 11355
Phone
(718) 463-2630
NPI assigned
Nov 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Christopher Georgiou
Title
Sole Proprieter
Phone
(718) 463-2630

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193400000X SINGLE SPECIALTY GROUP 173000000X 1937884 NY Primary

Addresses

Primary practice location

147-09 Elm Ave
Flushing, NY 11355

Mailing address

147-09 Elm Ave
Flushing, NY 11355
Phone (718) 463-2630

Other identifiers 1

IdentifierTypeStateIssuer
01685730MedicaidNY

National Provider Directory

National Provider Directory

Locations

14709 Elm Ave
Flushing, NY 11355
Phone (718) 463-2630

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386719557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147-09 ELM AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "11355",
            "telephone_number": "718-463-2630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147-09 ELM AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "11355",
            "telephone_number": "718-463-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM MEDICAL OF NEW YORK PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GEORGIOU",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "SOLE PROPRIETER",
        "authorized_official_telephone_number": "718-463-2630"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "NY",
            "license": "1937884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01685730",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.