Healthcare Provider Details

I. General information

NPI: 1457408486
Provider Name (Legal Business Name): CARITAS OB GYN SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 QUEENS BLVD
REGO PARK NY
11374-4511
US

IV. Provider business mailing address

9525 QUEENS BLVD
REGO PARK NY
11374-4511
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-2845
  • Fax:
Mailing address:
  • Phone: 718-830-2845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAHANGIR AYROMLOOI
Title or Position: PRESIDENT
Credential:
Phone: 718-830-2845