Healthcare Provider Details

I. General information

NPI: 1447528864
Provider Name (Legal Business Name): OPTIMAL HEALTH MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HEMPSTEAD TPKE
FARMINGDALE NY
11735-2518
US

IV. Provider business mailing address

101 HEMPSTEAD TPKE
FARMINGDALE NY
11735-2518
US

V. Phone/Fax

Practice location:
  • Phone: 516-755-5855
  • Fax: 516-755-0330
Mailing address:
  • Phone: 516-755-5855
  • Fax: 516-755-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number259884
License Number StateNY

VIII. Authorized Official

Name: DR. AJAY NARENDRA KIRI
Title or Position: OWNER
Credential: M.D.
Phone: 908-421-6101