Active NPI
SLB Medical Associates
- Pediatrics Physician
- Corona, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 156767
- Legal business name
- SLB MEDICAL ASSOCIATES
- Practice address
- 3765 104TH St
Corona, NY 11368-1947 - Phone
- (718) 507-5656
- Fax
- (718) 507-0884
- NPI assigned
- Jun 30, 2009
- Last updated
- Jun 30, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jean-Robert Boursiquot, MD
- Title
- Medical Director
- Phone
- (718) 507-5656
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 156767 | NY | Primary |
Addresses
Primary practice location
3765 104TH St
Corona, NY 11368-1947
Mailing address
3765 104TH St
Corona, NY 11368-1947
Phone (718) 507-5656
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01369497 | Medicaid | NY |
National Provider Directory
National Provider Directory- Tax ID family
- Queens Village Medical PC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Queens Village Medical PC
- Pediatrics Physician
- Queens Village, NY
- NPI 1518008648
Locations
3765 104th St
Corona, NY 11368
Phone (718) 507-5656
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pediatrics Physician
- Queens Village, NY
- NPI 1902987134
-
- Pediatrics Physician
- Corona, NY
- NPI 1275657793
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246320000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1246320000000",
"number": "1750519690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3765 104TH ST",
"city": "CORONA",
"state": "NY",
"postal_code": "113681947",
"telephone_number": "718-507-5656",
"fax_number": "718-507-0884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3765 104TH ST",
"city": "CORONA",
"state": "NY",
"postal_code": "113681947",
"telephone_number": "718-507-5656",
"fax_number": "718-507-0884"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SLB MEDICAL ASSOCIATES",
"organizational_subpart": "NO",
"enumeration_date": "2009-06-30",
"last_updated": "2009-06-30",
"status": "A",
"authorized_official_last_name": "BOURSIQUOT",
"authorized_official_first_name": "JEAN-ROBERT",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "718-507-5656",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "156767",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01369497",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corona, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.