Premium Medical of Ny,PC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

193788 Issued in NY

Legal business name

PREMIUM MEDICAL OF NY,PC

Practice address

14709 Elm Ave
Suite B1
Flushing, NY 11355-1705

Phone

(718) 445-1223

Fax

(718) 445-1539

NPI assigned

Apr 6, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Christopher Georgiou, MD

Title

President

Phone

(718) 445-1223

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1333670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333670400000",
    "number": "1972869675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14709 ELM AVE",
            "address_2": "SUITE B1",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113551705",
            "telephone_number": "718-445-1223",
            "fax_number": "718-445-1539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14709 ELM AVE",
            "address_2": "SUITE B1",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113551705",
            "telephone_number": "718-445-1223",
            "fax_number": "718-445-1539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM MEDICAL OF NY,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-06",
        "last_updated": "2012-04-06",
        "status": "A",
        "authorized_official_last_name": "GEORGIOU",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-445-1223",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "193788",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "193788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nephrology Physician in Flushing, NY
• Providers in Flushing, NY by specialty
• Nephrology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2012; 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.