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General NPI Number Information
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NPI Number | 1730822891
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Entity Type | Organization
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Legal Business Name | STAT DOC LLC
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 1075 PORTION RD
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City | FARMINGVILLE
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State | NY
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Zip | 11738-4205
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Country | US
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Telephone | 718-534-7888
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Fax | 718-874-0088
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Provider Business Mailing Address
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Address Line | 743 HILLSIDE AVE
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City | NORTH NEW HYDE PARK
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State | NY
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Zip | 11040-2515
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Country | US
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Telephone | 917-774-1787
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Fax | 718-874-0088
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Authorized Official
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Title or Position | CEO
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Name | SHAHID RASUL
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Credential | MD
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Telephone | 718-534-7888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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