Healthcare Provider Details

I. General information

NPI: 1124333885
Provider Name (Legal Business Name): PRIME MEDCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 RALPH AVE
BROOKLYN NY
11233-2206
US

IV. Provider business mailing address

295 RALPH AVE
BROOKLYN NY
11233-2206
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-0717
  • Fax: 718-604-0718
Mailing address:
  • Phone: 718-604-0717
  • Fax: 718-604-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PERVEZ QURESHI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 347-242-6261