MEDICARE: IMTIAZ MEDICAL CARE PLLC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1578014197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMTIAZ MEDICAL CARE PLLC

Provider Business Mailing Address
First Line	:	346 CONEY ISLAND AVE STE 50
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1804
Country	:	US
Telephone Number	:	917-676-0085
Fax Number	:

Provider Business Practice Location Address
First Line	:	346 CONEY ISLAND AVE STE 50
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1804
Country	:	US
Telephone Number	:	917-676-0085
Fax Number	:

Authorized Official
Title or Position	:	ADMIN ASSISTANT
Name	:	MUHAMMAD A MOMEN
Credential	:
Telephone Number	:	917-676-0085

Provider Enumeration Date	:	10/19/2016
Last Update Date	:	12/19/2018

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