Queens Medical Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

3358 Issued in NY

Legal business name

QUEENS MEDICAL LABORATORY

Practice address

43 Mineola Ave
Roslyn Heights, NY 11577-1033

Phone

(516) 626-4101

Fax

(516) 626-4104

NPI assigned

Mar 29, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Nathaniel Dworkin

Title

Supervisor

Phone

(516) 626-4101

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523404800000",
    "number": "1992825772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 UNION TPKE STE 204",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110401759",
            "telephone_number": "516-626-4101",
            "fax_number": "516-626-4104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 MINEOLA AVE",
            "city": "ROSLYN HEIGHTS",
            "state": "NY",
            "postal_code": "115771033",
            "telephone_number": "516-626-4101",
            "fax_number": "516-626-4104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEENS MEDICAL LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2018-04-11",
        "status": "A",
        "authorized_official_last_name": "DWORKIN",
        "authorized_official_first_name": "NATHANIEL",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "516-626-4101",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NY",
            "license": "3358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; 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.