Healthcare Provider Details

I. General information

NPI: 1861720963
Provider Name (Legal Business Name): MEACHAM MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 MEACHAM AVE
ELMONT NY
11003-3221
US

IV. Provider business mailing address

374 MEACHAM AVE
ELMONT NY
11003-3221
US

V. Phone/Fax

Practice location:
  • Phone: 516-599-2383
  • Fax:
Mailing address:
  • Phone: 516-599-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number236725
License Number StateNY

VIII. Authorized Official

Name: FARAH AZIZ
Title or Position: BILLER
Credential:
Phone: 917-324-5842