Provider Demographics
NPI:1447480439
Name:Q-CARE AFFORDABLE MEDICAL CARE, PLLC
Entity type:Organization
Organization Name:Q-CARE AFFORDABLE MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:CHARLOTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-606-0187
Mailing Address - Street 1:4150 78TH ST
Mailing Address - Street 2:SUITE #102/103
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1950
Mailing Address - Country:US
Mailing Address - Phone:718-606-0187
Mailing Address - Fax:718-606-0958
Practice Address - Street 1:4150 78TH ST
Practice Address - Street 2:SUITE 102/103
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1950
Practice Address - Country:US
Practice Address - Phone:718-606-0187
Practice Address - Fax:718-606-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02230353Medicaid
NYH89019Medicare UPIN
NY73V141Medicare PIN