Healthcare Provider Details

I. General information

NPI: 1700047289
Provider Name (Legal Business Name): CLERISY MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 MCDONALD AVE
BROOKLYN NY
11218-2212
US

IV. Provider business mailing address

114 TALLEY RD S
ROSLYN NY
11576-2598
US

V. Phone/Fax

Practice location:
  • Phone: 718-972-4200
  • Fax: 718-972-6861
Mailing address:
  • Phone: 718-421-2131
  • Fax: 718-421-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number228737
License Number StateNY

VIII. Authorized Official

Name: DR. GULAM M KHAN
Title or Position: OWNER
Credential: M.D.
Phone: 718-840-7142