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General NPI Number Information
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NPI Number | 1205789393
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Entity Type | Organization
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Legal Business Name | QUEENS ATLANTIC MEDICAL, PLLC
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 10919 72ND RD
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City | FOREST HILLS
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State | NY
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Zip | 11375-7826
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Country | US
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Telephone | 718-268-0418
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Fax |
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Provider Business Mailing Address
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Address Line | 10919 72ND RD
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City | FOREST HILLS
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State | NY
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Zip | 11375-7826
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Country | US
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Telephone | 718-268-3161
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AZEEM KHAN
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Credential | MD
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Telephone | 516-578-8271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number |
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License Number State |
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