Healthcare Provider Details

I. General information

NPI: 1629850250
Provider Name (Legal Business Name): QAISS MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 DARBY RD
PAOLI PA
19301-1472
US

IV. Provider business mailing address

53 DARBY RD
PAOLI PA
19301-1472
US

V. Phone/Fax

Practice location:
  • Phone: 718-909-7380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: QAISS MOHAMMED
Title or Position: OWNER
Credential: MD
Phone: 718-909-7380