Healthcare Provider Details

I. General information

NPI: 1477863900
Provider Name (Legal Business Name): SUPREME MEDICAL CARE, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18911 JAMAICA AVE
HOLLIS NY
11423-2513
US

IV. Provider business mailing address

237 CUSHING AVE
WILLISTON PARK NY
11596-1050
US

V. Phone/Fax

Practice location:
  • Phone: 718-479-1100
  • Fax: 718-479-1103
Mailing address:
  • Phone: 516-633-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number207297
License Number StateNY

VIII. Authorized Official

Name: DR. AHSAN NAZIR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-633-9508