Healthcare Provider Details

I. General information

NPI: 1225559990
Provider Name (Legal Business Name): PS MEDICAL CARE OF ELMONT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20B MEACHAM AVE
ELMONT NY
11003-2654
US

IV. Provider business mailing address

20B MEACHAM AVE
ELMONT NY
11003-2654
US

V. Phone/Fax

Practice location:
  • Phone: 516-502-9355
  • Fax: 888-858-2068
Mailing address:
  • Phone: 516-502-9355
  • Fax: 888-858-2068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FATIMA KHAN
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 501-766-4777