Provider Demographics
NPI:1194137109
Name:JACKSON HEIGHTS MEDICAL CENTER
Entity type:Organization
Organization Name:JACKSON HEIGHTS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-565-2949
Mailing Address - Street 1:7535 31ST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1857
Mailing Address - Country:US
Mailing Address - Phone:718-565-2949
Mailing Address - Fax:
Practice Address - Street 1:7535 31ST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1857
Practice Address - Country:US
Practice Address - Phone:718-565-2949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-24
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty