Healthcare Provider Details

I. General information

NPI: 1417448234
Provider Name (Legal Business Name): HOLLIS PRIMARY CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 22 HILLSIDE AVE
HOLLIS NY
11423
US

IV. Provider business mailing address

14 CAPRI DR
ROSLYN NY
11576-3205
US

V. Phone/Fax

Practice location:
  • Phone: 347-390-0612
  • Fax:
Mailing address:
  • Phone: 917-399-2374
  • Fax: 718-480-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number257463
License Number StateNY

VIII. Authorized Official

Name: DR. MOHD HOSSAIN
Title or Position: M.D.
Credential:
Phone: 917-399-2374