Provider Demographics
NPI:1417354929
Name:QUEENS-NASSAU MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:QUEENS-NASSAU MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:KOPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-678-4725
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE W260
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2061
Mailing Address - Country:US
Mailing Address - Phone:516-678-4725
Mailing Address - Fax:516-678-3488
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE W260
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2061
Practice Address - Country:US
Practice Address - Phone:516-678-4725
Practice Address - Fax:516-678-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty