Healthcare Provider Details

I. General information

NPI: 1992057392
Provider Name (Legal Business Name): DR.AFSER TASNEEM MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16833 HILLSIDE AVE
JAMAICA NY
11432-4440
US

IV. Provider business mailing address

16833 HILLSIDE AVE
JAMAICA NY
11432-4440
US

V. Phone/Fax

Practice location:
  • Phone: 718-291-5270
  • Fax: 718-291-5271
Mailing address:
  • Phone: 718-291-5270
  • Fax: 718-291-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number234120
License Number StateNY

VIII. Authorized Official

Name: DR. AFSER TASNEEM
Title or Position: DOCTOR
Credential: M.D
Phone: 718-291-5270