Healthcare Provider Details

I. General information

NPI: 1740461334
Provider Name (Legal Business Name): PRIME CARE MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16806 HILLSIDE AVE
JAMAICA NY
11432-4341
US

IV. Provider business mailing address

16806 HILLSIDE AVE
JAMAICA NY
11432-4341
US

V. Phone/Fax

Practice location:
  • Phone: 718-739-7400
  • Fax: 718-739-7413
Mailing address:
  • Phone: 718-739-7400
  • Fax: 718-739-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number230830
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number242628
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number244121
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005475
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number229868
License Number StateNY

VIII. Authorized Official

Name: IFFAT ARA SADIQUE
Title or Position: OWNER
Credential: MD
Phone: 718-739-7400