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General NPI Number Information
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NPI Number | 1811810146
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Entity Type | Organization
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Legal Business Name | MEDALLION CARE SERVICES FL PA
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 200 N LAURA ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3513
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Country | US
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Telephone | 718-470-0288
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Fax |
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Provider Business Mailing Address
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Address Line | 407 WILLOUGHBY AVE
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City | BROOKLYN
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State | NY
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Zip | 11205-4590
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AZLAN TARIQ
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Credential |
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Telephone | 718-470-0288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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