Premier Pet Management of Queens LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

1124741 Issued in NY

Legal business name

PREMIER PET MANAGEMENT OF QUEENS LLC

Practice address

10202 Queens Blvd
Forest Hills, NY 11375-3197

Phone

(718) 896-7600

Fax

(718) 896-7601

NPI assigned

Nov 24, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Lucille Patricia Taverna, M.DNPI 1235131764

Title

Medical Director

Phone

(516) 255-9555

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• forest hills pet imaging pc Doing business as

Practitioners 1

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

• Lucille Patricia Taverna, MD

  • Diagnostic Radiology Physician
  • Oceanside, NY
  • NPI 1235131764
  NPD (past) Authorized official

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1598830424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10202 QUEENS BLVD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113753197",
            "telephone_number": "718-896-7600",
            "fax_number": "718-896-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10202 QUEENS BLVD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113753197",
            "telephone_number": "718-896-7600",
            "fax_number": "718-896-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PET MANAGEMENT OF QUEENS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "TAVERNA",
        "authorized_official_first_name": "LUCILLE",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "516-255-9555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "1124741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00380218",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "forest hills pet imaging pc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Prava Medical, Inc.
• Preferred Health Medical Care PC
• Jana I Preis, MD, MPH
• Michelle Fran Preiss-Lowenwirt, M.D.
• Premier Medical for Sport & Rehabilitation, P.C.
• Premier Physicians of New York PLLC
• Natalie Prevost
• Hadas Pri Paz
• Corey Priam, LMHC
• David Delroy Price, LCSWR

• Diagnostic Radiology Physician in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; 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.