Healthcare Provider Details

I. General information

NPI: 1871038315
Provider Name (Legal Business Name): WESTERN CARE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7017 37TH AVE 1ST FLR
JACKSON HEIGHTS NY
11372-3922
US

IV. Provider business mailing address

7017 37TH AVE 1ST FLR
JACKSON HEIGHTS NY
11372-3922
US

V. Phone/Fax

Practice location:
  • Phone: 718-565-5600
  • Fax: 718-565-5600
Mailing address:
  • Phone: 718-565-5600
  • Fax: 718-565-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number22523
License Number StateNY

VIII. Authorized Official

Name: FERDOUS KHANDKER
Title or Position: M.D.
Credential:
Phone: 718-565-5600