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General NPI Number Information
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NPI Number | 1346472495
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Entity Type | Organization
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Legal Business Name | PROVIDER MEDICAL CARE PC
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 7616 BAY PARKWAY 1 FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11214-1516
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Country | US
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Telephone | 516-225-9059
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Fax |
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Provider Business Mailing Address
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Address Line | 7616 BAY PARKWAY 1 FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11214-1516
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Country | US
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Telephone | 718-943-0100
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Fax | 718-943-0101
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELHAN SULEY
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Credential | DO
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Telephone | 516-225-9059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 227423
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License Number State | NY
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