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General NPI Number Information
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NPI Number | 1043563554
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Entity Type | Organization
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Legal Business Name | OPTIMUM PRIMARY CARE MEDICAL PC
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 311 ST. NICHOLAS AVENUE
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City | RIDGEWOOD
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State | NY
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Zip | 11385
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Country | US
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Telephone | 718-766-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 52 WOODHOLLOW RD
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577-2217
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Country | US
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Telephone | 516-361-4600
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Fax |
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Authorized Official
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Title or Position | M,D,
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Name | DR. MOHAMMAD ASLAM
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Credential | M.D.
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Telephone | 516-361-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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