Healthcare Provider Details

I. General information

NPI: 1205789393
Provider Name (Legal Business Name): QUEENS ATLANTIC MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10919 72ND RD
FOREST HILLS NY
11375-7826
US

IV. Provider business mailing address

10919 72ND RD
FOREST HILLS NY
11375-7826
US

V. Phone/Fax

Practice location:
  • Phone: 718-268-0418
  • Fax:
Mailing address:
  • Phone: 718-268-0418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: AZEEM KHAN
Title or Position: OWNER
Credential: MD
Phone: 718-268-0418