Healthcare Provider Details

I. General information

NPI: 1326532698
Provider Name (Legal Business Name): HOLLIS MEDICAL OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 JAMAICA AVE
HOLLIS NY
11423-2664
US

IV. Provider business mailing address

19550 JAMAICA AVE
HOLLIS NY
11423-2664
US

V. Phone/Fax

Practice location:
  • Phone: 718-776-9899
  • Fax: 718-776-5005
Mailing address:
  • Phone: 718-776-9899
  • Fax: 718-776-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number182925
License Number StateNY

VIII. Authorized Official

Name: DR. SYLVESTER A OZOUDE
Title or Position: INTERNAL MEDICINE
Credential: MD
Phone: 718-776-9899