Healthcare Provider Details

I. General information

NPI: 1043216633
Provider Name (Legal Business Name): ADAM HOM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 66TH RD
FLUSHING NY
11375-2029
US

IV. Provider business mailing address

11781 LEE JACKSON MEMORIAL HWY SUITE 550
FAIRFAX VA
22033-3309
US

V. Phone/Fax

Practice location:
  • Phone: 917-837-2030
  • Fax:
Mailing address:
  • Phone: 571-777-5157
  • Fax: 703-890-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number188884
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: