=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750105375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MY HEALTH URGENT CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2024
-----------------------------------------------------
Last Update Date | 11/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4010 AVENUE J STE 1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11210-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-266-9779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 100042
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11210-0042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-266-9779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | SAMIRA OVSHAEV
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 718-266-9779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------