Healthcare Provider Details

I. General information

NPI: 1104199405
Provider Name (Legal Business Name): JMSK MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22648 76TH AVE
BAYSIDE NY
11364-3129
US

IV. Provider business mailing address

22648 76TH AVE
BAYSIDE NY
11364-3129
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-6322
  • Fax:
Mailing address:
  • Phone: 718-464-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name: RAMKUMAR PANHANI
Title or Position: OWNER
Credential: MD
Phone: 718-464-6322