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General NPI Number Information
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NPI Number | 1578014197
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Entity Type | Organization
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Legal Business Name | IMTIAZ MEDICAL CARE PLLC
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 346 CONEY ISLAND AVE STE 50
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City | BROOKLYN
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State | NY
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Zip | 11218-1804
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Country | US
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Telephone | 917-676-0085
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Fax |
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Provider Business Mailing Address
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Address Line | 346 CONEY ISLAND AVE STE 50
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City | BROOKLYN
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State | NY
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Zip | 11218-1804
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Country | US
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Telephone | 917-676-0085
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Fax |
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Authorized Official
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Title or Position | ADMIN ASSISTANT
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Name | MUHAMMAD A MOMEN
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Credential |
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Telephone | 917-676-0085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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