=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598380701
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMADUDDIN HASHMI MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2020
-----------------------------------------------------
Last Update Date | 02/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 527 CONEY ISLAND AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11218-3466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-306-5025
-----------------------------------------------------
Fax | 718-462-8000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 62 NEW ST
-----------------------------------------------------
City | LYNBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11563-3309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-977-1121
-----------------------------------------------------
Fax | 718-462-8000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. IMADUDDIN HASHMI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-306-5025
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------