Provider Demographics
NPI:1316112097
Name:CORNERSTONE OF MEDICAL ARTS CENTER HOSPITAL
Entity type:Organization
Organization Name:CORNERSTONE OF MEDICAL ARTS CENTER HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KADDOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-906-6700
Mailing Address - Street 1:15905 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366
Mailing Address - Country:US
Mailing Address - Phone:718-906-6700
Mailing Address - Fax:
Practice Address - Street 1:15905 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366
Practice Address - Country:US
Practice Address - Phone:718-906-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303637324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility