| Organization Name: | WOODSIDE MEDICAL CARE |
| NPI Number: | 1003287343 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANIEL PARK (PRESIDENT) |
| Mailing Address: | 6014 Roosevelt Ave Ste 7 Woodside |
| State: | NY US |
| Postal Code: | 113773538 |
| Phone Number: | 7184466570 |
| Fax Number: | |
| NPI Enumeration Date: | 10/13/2015 |
| NPI Last Update Date: | 10/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 209387 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |