Healthcare Provider Details

I. General information

NPI: 1659607125
Provider Name (Legal Business Name): GRAHAM MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 GRAHAM AVE
BROOKLYN NY
11206-2609
US

IV. Provider business mailing address

121 GRAHAM AVE
BROOKLYN NY
11206-2609
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-0276
  • Fax: 718-963-0277
Mailing address:
  • Phone: 718-963-0276
  • Fax: 718-963-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number173545-1
License Number StateNY

VIII. Authorized Official

Name: NESSIM ROUMI
Title or Position: PRESIDENT
Credential: M.D
Phone: 718-963-0276