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General NPI Number Information
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NPI Number | 1700047289
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Entity Type | Organization
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Legal Business Name | CLERISY MEDICAL, PC
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 446 MCDONALD AVE
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City | BROOKLYN
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State | NY
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Zip | 11218-2212
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Country | US
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Telephone | 718-972-4200
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Fax | 718-972-6861
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Provider Business Mailing Address
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Address Line | 114 TALLEY RD S
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City | ROSLYN
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State | NY
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Zip | 11576-2598
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Country | US
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Telephone | 718-421-2131
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Fax | 718-421-2130
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Authorized Official
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Title or Position | OWNER
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Name | DR. GULAM M KHAN
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Credential | M.D.
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Telephone | 718-840-7142
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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 | 228737
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License Number State | NY
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