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General NPI Number Information
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NPI Number | 1225002785
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Entity Type | Organization
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Legal Business Name | MEDICAL OFFICE PC
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 120 OLD FARMERS LN
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City | STATEN ISLAND
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State | NY
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Zip | 10304-1404
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Country | US
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Telephone | 718-306-5025
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Fax | 718-462-8000
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Provider Business Mailing Address
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Address Line | 62 NEW ST
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City | LYNBROOK
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State | NY
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Zip | 11563-3309
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Country | US
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Telephone | 718-306-5025
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Fax | 718-462-8000
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. IMADUDDIN HASHMI
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Credential | M.D.
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Telephone | 718-306-5025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 184579
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License Number State | NY
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