Healthcare Provider Details

I. General information

NPI: 1205172103
Provider Name (Legal Business Name): HIV PRIMARY CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E 183RD ST
BRONX NY
10453-1237
US

IV. Provider business mailing address

1 DEER PARK RD
ORANGEBURG NY
10962-1808
US

V. Phone/Fax

Practice location:
  • Phone: 718-295-4600
  • Fax:
Mailing address:
  • Phone: 845-365-6173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number184129
License Number StateNY

VIII. Authorized Official

Name: GHAZANFAR ABDULLAH
Title or Position: M.D.
Credential:
Phone: 845-365-6173