=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205944261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMAICA MEDICAL CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 03/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17206 JAMAICA AVE
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-5522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-526-4211
-----------------------------------------------------
Fax | 718-526-4166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17206 JAMAICA AVE
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-5522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-526-4211
-----------------------------------------------------
Fax | 718-526-4166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TRISTAN DA CUNHA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-526-4211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 213299
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------