Provider Demographics
NPI:1366833352
Name:LOYAL MEDICAL PC
Entity type:Organization
Organization Name:LOYAL MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATSUKO
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKESHIGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-661-4800
Mailing Address - Street 1:4242 COLDEN ST APT L17
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4855
Mailing Address - Country:US
Mailing Address - Phone:718-661-4800
Mailing Address - Fax:718-888-2701
Practice Address - Street 1:4242 COLDEN ST APT L17
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4855
Practice Address - Country:US
Practice Address - Phone:718-661-4800
Practice Address - Fax:718-888-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09434100261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0460931Medicaid