Healthcare Provider Details

I. General information

NPI: 1649605932
Provider Name (Legal Business Name): GHUMMAN MEDICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21838 HILLSIDE AVE
QUEENS VILLAGE NY
11427-1916
US

IV. Provider business mailing address

237 CENTER ST
WILLISTON PARK NY
11596-1006
US

V. Phone/Fax

Practice location:
  • Phone: 718-465-7746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number189683
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number189683
License Number StateNY

VIII. Authorized Official

Name: CHAUDHRY M GHUMMAN
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 718-465-7746