Healthcare Provider Details

I. General information

NPI: 1255215828
Provider Name (Legal Business Name): CORONA FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3758 108TH ST
CORONA NY
11368-2023
US

IV. Provider business mailing address

1025 ISLIP AVE
CENTRAL ISLIP NY
11722-4819
US

V. Phone/Fax

Practice location:
  • Phone: 718-592-1616
  • Fax:
Mailing address:
  • Phone: 631-234-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LAEEQ AHMAD
Title or Position: OWNER
Credential: M.D
Phone: 917-446-0320