Healthcare Provider Details

I. General information

NPI: 1467593889
Provider Name (Legal Business Name): JACKSON HEIGHTS MED OFF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3758 72 STREET
JACKSON HEIGHTS NY
11372
US

IV. Provider business mailing address

671 COLLEGE ROAD
FARMINGVILLE NY
11738
US

V. Phone/Fax

Practice location:
  • Phone: 718-426-1000
  • Fax: 718-426-1100
Mailing address:
  • Phone: 718-426-1000
  • Fax: 718-426-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number197647
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number197647
License Number StateNY

VIII. Authorized Official

Name: NUZHAT FARIDI
Title or Position: MD
Credential: MD
Phone: 718-426-1000