Provider Demographics
NPI:1306906243
Name:QUEENS COUNTY NEUROPSYCHIATRIC INSTITUTE INC.
Entity type:Organization
Organization Name:QUEENS COUNTY NEUROPSYCHIATRIC INSTITUTE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAILLACE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-779-2434
Mailing Address - Street 1:37 64 72ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6143
Mailing Address - Country:US
Mailing Address - Phone:718-335-3434
Mailing Address - Fax:718-335-4731
Practice Address - Street 1:37 64 72ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON HTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6143
Practice Address - Country:US
Practice Address - Phone:718-335-3434
Practice Address - Fax:718-335-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6736120A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00249610Medicaid
NY00249610Medicaid