Healthcare Provider Details

I. General information

NPI: 1114201340
Provider Name (Legal Business Name): MEDICAL OFFICE OF ANAND R PERSAUD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17325 JAMAICA AVE
JAMAICA NY
11432-5523
US

IV. Provider business mailing address

17325 JAMAICA AVE
JAMAICA NY
11432-5523
US

V. Phone/Fax

Practice location:
  • Phone: 718-657-4000
  • Fax: 718-657-6000
Mailing address:
  • Phone: 718-657-4000
  • Fax: 718-657-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ANAND R PERSAUD
Title or Position: OWNER
Credential: MD
Phone: 516-623-5900