Healthcare Provider Details

I. General information

NPI: 1689018509
Provider Name (Legal Business Name): HEALTH MED PHYSICIAN P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 DUBLIN CT
LATHAM NY
12110-3708
US

IV. Provider business mailing address

344 GROVE ST 12
JERSEY CITY NJ
07302-5923
US

V. Phone/Fax

Practice location:
  • Phone: 508-739-0826
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: AFROZA SULTANA LITON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 508-739-0826