Healthcare Provider Details

I. General information

NPI: 1548410780
Provider Name (Legal Business Name): DREAM MEDICAL CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10311 NORTHERN BLVD
CORONA NY
11368-1136
US

IV. Provider business mailing address

10311 NORTHERN BLVD
CORONA NY
11368-1136
US

V. Phone/Fax

Practice location:
  • Phone: 718-205-0500
  • Fax: 718-205-0505
Mailing address:
  • Phone: 718-205-0500
  • Fax: 718-205-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number233937
License Number StateNY

VIII. Authorized Official

Name: DR. KAMAL KHAN
Title or Position: MD
Credential:
Phone: 718-205-0500