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General NPI Number Information
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NPI Number | 1750712220
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Entity Type | Organization
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Legal Business Name | 210 MJD MEDICAL, PLLC
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 228 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3618
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Country | US
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Telephone | 917-847-4980
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Fax | 833-424-4357
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Provider Business Mailing Address
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Address Line | 249 OLD COUNTRY RD
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City | CARLE PLACE
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State | NY
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Zip | 11514-2024
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Country | US
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Telephone | 917-847-4980
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Fax | 833-424-4357
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | DINESH VERMA
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Credential |
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Telephone | 917-847-4980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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