Healthcare Provider Details

I. General information

NPI: 1063424505
Provider Name (Legal Business Name): NOSTRAND COMMUNITY MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2968 AVENUE X
BROOKLYN NY
11235-1808
US

IV. Provider business mailing address

2968 AVENUE X
BROOKLYN NY
11235-1808
US

V. Phone/Fax

Practice location:
  • Phone: 718-769-7988
  • Fax: 718-769-4415
Mailing address:
  • Phone: 718-769-4988
  • Fax: 718-769-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number226710
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number226710
License Number StateNY

VIII. Authorized Official

Name: DR. ISMAIL M ELHAM
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 718-769-4988