=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336515675
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD HEALTH MEDICAL CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2015
-----------------------------------------------------
Last Update Date | 08/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4370 KISSENA BLVD APT 2D
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-3769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-216-5767
-----------------------------------------------------
Fax | 718-303-0763
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4370 KISSENA BLVD APT 2D
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-3769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-216-5767
-----------------------------------------------------
Fax | 718-303-0763
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D
-----------------------------------------------------
Name | ALTAF H SHAIK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-216-5767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 252163-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------