Healthcare Provider Details

I. General information

NPI: 1760439509
Provider Name (Legal Business Name): 786 MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 DITMARS BLVD
ASTORIA NY
11105-2108
US

IV. Provider business mailing address

3511 DITMARS BLVD
ASTORIA NY
11105-2108
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-0006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number132562
License Number StateNY

VIII. Authorized Official

Name: MUHAMMAD RAFIQ CHAUDHRY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 212-996-0006