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General NPI Number Information
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NPI Number | 1295454650
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Entity Type | Organization
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Legal Business Name | HOLLIS AK LLC
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Dates
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Enumeration Date | 08/26/2022
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 19002 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11423-2034
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Country | US
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Telephone | 718-577-2211
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Fax | 929-399-7959
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Provider Business Mailing Address
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Address Line | 19002 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11423-2034
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Country | US
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Telephone | 718-577-2211
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Fax | 929-399-7959
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARI KALONTAROV
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Credential |
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Telephone | 347-245-2279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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