=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811771199
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MY CARE NP IN ADULT HEALTH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2023
-----------------------------------------------------
Last Update Date | 11/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35-08 JUNCTION BOULEVARD
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-302-1143
-----------------------------------------------------
Fax | 718-504-6979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35-08 JUNCTION BOULEVARD
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ARIF REHMAT MASIH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-302-1143
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------