Provider Demographics
NPI:1982809836
Name:IVY MEDICAL SERVICES PC
Entity type:Organization
Organization Name:IVY MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING
Authorized Official - Prefix:DR
Authorized Official - First Name:QIONG
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:718-321-3522
Mailing Address - Street 1:15 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1212
Mailing Address - Country:US
Mailing Address - Phone:718-321-3522
Mailing Address - Fax:
Practice Address - Street 1:3808 UNION ST APT 3J
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5500
Practice Address - Country:US
Practice Address - Phone:718-321-3522
Practice Address - Fax:718-321-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07425Medicare ID - Type Unspecified