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General NPI Number Information
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NPI Number | 1538416466
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Entity Type | Organization
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Legal Business Name | MSU MEDICAL PC
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 84 05 169TH STREET
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City | JAMAICA HILLS
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State | NY
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Zip | 11432
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Country | US
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Telephone | 718-657-8001
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Fax | 718-732-0783
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Provider Business Mailing Address
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Address Line | 84 05 169TH STREET
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City | JAMAICA HILLS
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State | NY
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Zip | 11432
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Country | US
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Telephone | 718-657-8001
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Fax | 718-732-0783
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Authorized Official
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Title or Position | OWNER-PRESIDENT
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Name | DR. MOHAMMED ULLAH
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Credential | MD
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Telephone | 917-293-3414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 249483
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License Number State | NY
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