Healthcare Provider Details

I. General information

NPI: 1598030488
Provider Name (Legal Business Name): INDO AMERICAN PEDIATRICS P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 BROADWAY SUITE 1F
ELMHURST NY
11373
US

IV. Provider business mailing address

8020 BROADWAY SUITE 1F
ELMHURST NY
11373
US

V. Phone/Fax

Practice location:
  • Phone: 718-396-9643
  • Fax: 718-396-9645
Mailing address:
  • Phone: 718-396-9643
  • Fax: 718-396-9645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number214969
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02134238
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DR. QURRATH U AIN
Title or Position: PRESIDENT
Credential: M.D
Phone: 718-396-9643