Provider Demographics
NPI:1366938235
Name:URGENT CARE OF ASTORIA, P.C
Entity type:Organization
Organization Name:URGENT CARE OF ASTORIA, P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE CONTRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TANESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE-PHILOGENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-770-7228
Mailing Address - Street 1:3274 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4006
Mailing Address - Country:US
Mailing Address - Phone:718-721-0101
Mailing Address - Fax:
Practice Address - Street 1:3274 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4006
Practice Address - Country:US
Practice Address - Phone:718-721-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205420207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty