MEDICARE: GONDAL MEDICAL CARE P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	239419	NY

General Provider Information

NPI Number	:	1134356397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GONDAL MEDICAL CARE P.C.

Provider Business Mailing Address
First Line	:	731 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4306
Country	:	US
Telephone Number	:	718-693-7777
Fax Number	:	718-693-7770

Provider Business Practice Location Address
First Line	:	731 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4306
Country	:	US
Telephone Number	:	718-693-7777
Fax Number	:	718-693-7770

Authorized Official
Title or Position	:	OWNER
Name	:	IMTIAZ AHMAD
Credential	:	M.D.
Telephone Number	:	718-693-7777

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	06/16/2009

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