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General NPI Number Information
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NPI Number | 1821203647
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Entity Type | Organization
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Legal Business Name | PACE MEDICAL PC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13681 ROOSEVELT AVE 3RD FLOOR
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City | FLUSHING
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State | NY
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Zip | 11354-5503
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Country | US
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Telephone | 718-886-8872
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Fax | 718-886-8840
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Provider Business Mailing Address
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Address Line | 13681 ROOSEVELT AVE 3RD FLOOR
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City | FLUSHING
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State | NY
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Zip | 11354-5503
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Country | US
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Telephone | 718-886-8872
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Fax | 718-886-8840
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Authorized Official
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Title or Position | CONTACT
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Name | SARURUL KHAN
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Credential | MD
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Telephone | 718-886-8872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 100704
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License Number State | NY
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