Healthcare Provider Details

I. General information

NPI: 1295768935
Provider Name (Legal Business Name): OLYMPUS HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16521 CHAPIN PKWY
JAMAICA NY
11432-1807
US

IV. Provider business mailing address

16521 CHAPIN PKWY
JAMAICA NY
11432-1807
US

V. Phone/Fax

Practice location:
  • Phone: 718-523-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number187169
License Number StateNY

VIII. Authorized Official

Name: SHAKIR MUKHI
Title or Position: SOLE PROPRIETER
Credential:
Phone: 718-523-8600