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General NPI Number Information
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NPI Number | 1033503578
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Entity Type | Organization
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Legal Business Name | CHOICE MEDICAL CARE PC
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Dates
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Enumeration Date | 03/23/2015
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Last Update Date | 03/23/2015
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Provider Practice Location Address
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Address Line | 9217 101ST AVE
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City | OZONE PARK
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State | NY
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Zip | 11416-2316
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Country | US
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Telephone | 412-452-4262
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Fax |
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Provider Business Mailing Address
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Address Line | 10414 113TH ST
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-2506
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Country | US
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Telephone | 412-452-4262
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MANSOOR KHAN
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Credential | DO
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Telephone | 412-452-4262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 265529
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License Number State | NY
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