Healthcare Provider Details

I. General information

NPI: 1164757704
Provider Name (Legal Business Name): COMMUNITY MEDICAL CARE OF N.Y., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 GRAND CONCOURSE 2ND FLOOR
BRONX NY
10453-4994
US

IV. Provider business mailing address

1963 GRAND CONCOURSE 2ND FLOOR
BRONX NY
10453-4994
US

V. Phone/Fax

Practice location:
  • Phone: 718-294-5000
  • Fax: 718-294-6060
Mailing address:
  • Phone: 718-294-5000
  • Fax: 718-294-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number196049
License Number StateNY

VIII. Authorized Official

Name: DR. AHMAD RIAZ
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 718-294-5000