Healthcare Provider Details

I. General information

NPI: 1063519304
Provider Name (Legal Business Name): HUSAM K RIMAWI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6317 4TH AVE PARK RIDGE FAMILY HEALTH
BROOKLYN NY
11220-4922
US

IV. Provider business mailing address

6317 4TH AVE PARK RIDGE FAMILY HEALTH
BROOKLYN NY
11220-4922
US

V. Phone/Fax

Practice location:
  • Phone: 718-907-8100
  • Fax: 718-492-8614
Mailing address:
  • Phone: 718-907-8100
  • Fax: 718-492-8614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number142234
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: