Healthcare Provider Details

I. General information

NPI: 1205128972
Provider Name (Legal Business Name): FOREST HILLS AMBULATORY MEDICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10818 72ND AVE
FOREST HILLS NY
11375-5339
US

IV. Provider business mailing address

7211 AUSTIN ST # 481
FOREST HILLS NY
11375-5354
US

V. Phone/Fax

Practice location:
  • Phone: 718-544-1171
  • Fax:
Mailing address:
  • Phone: 718-544-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MIKHAIL KOGAN
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 718-544-1171