Healthcare Provider Details

I. General information

NPI: 1851733323
Provider Name (Legal Business Name): JAVEED AHMED RANGREZ BO, CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4223 FRANCIS LEWIS BLVD # M201
BAYSIDE NY
11361-2575
US

IV. Provider business mailing address

4223 FRANCIS LEWIS BLVD # M201
BAYSIDE NY
11361-2575
US

V. Phone/Fax

Practice location:
  • Phone: 718-952-4341
  • Fax: 833-652-1544
Mailing address:
  • Phone: 718-952-4341
  • Fax: 833-652-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC49842
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberC49842
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberC49842
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: