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General NPI Number Information
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NPI Number | 1497290894
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Entity Type | Organization
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Legal Business Name | NASSIM MEDICAL, P.C.
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 138-48 ELDER AVE.
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City | FLUSHING
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State | NY
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Zip | 11355-4066
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Country | US
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Telephone | 718-321-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 NORTHERN BLVD. SUITE 375
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City | GREAT NECK
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State | NY
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Zip | 11021-5312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ROLAND NASSIM
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Credential | M.D.
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Telephone | 718-321-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 176223
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 279137
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License Number State | NY
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