Healthcare Provider Details

I. General information

NPI: 1649253287
Provider Name (Legal Business Name): TARIQ JAMIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 AVENUE P
BROOKLYN NY
11229-1009
US

IV. Provider business mailing address

1 GUSTAVE L. LEVY PLACE BOX 1030
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 718-376-1004
  • Fax:
Mailing address:
  • Phone: 212-427-1540
  • Fax: 212-410-7196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number210477
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: