Healthcare Provider Details

I. General information

NPI: 1033554688
Provider Name (Legal Business Name): FASTTRACK URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6273 WOODHAVEN BLVD
REGO PARK NY
11374-2832
US

IV. Provider business mailing address

PO BOX 230207
BROOKLYN NY
11223-0207
US

V. Phone/Fax

Practice location:
  • Phone: 718-595-1100
  • Fax: 718-595-1200
Mailing address:
  • Phone: 718-645-2555
  • Fax: 718-645-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RAJENDRA D BHAYANI
Title or Position: PRESIDENT
Credential: MD
Phone: 718-249-9383