1336406057 NPI number — QUALITY HEALTH FAMILY MEDICAL CARE PC

Table of content: DR. YVETTE MICHELLE BOLES PSY.D. (NPI 1578152617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336406057 NPI number — QUALITY HEALTH FAMILY MEDICAL CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY HEALTH FAMILY MEDICAL CARE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336406057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 DUNSTER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT NECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-801-1627
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 E. MERRICK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY STREAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-801-1627
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GAYSYNSKY
Authorized Official First Name:
JULY
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
718-801-1627

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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