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General NPI Number Information
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NPI Number | 1932389731
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Entity Type | Organization
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Legal Business Name | PARK PLACE MEDICAL P.C.
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 2912 210TH PL
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City | BAYSIDE
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State | NY
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Zip | 11360-2433
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Country | US
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Telephone | 718-773-2011
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Fax | 718-773-3728
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Provider Business Mailing Address
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Address Line | 910 PARK PL SUITE 1-B
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City | BROOKLYN
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State | NY
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Zip | 11216-4000
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Country | US
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Telephone | 718-773-2011
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Fax | 718-773-3728
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHAMMED MANSOUR
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Credential | M.D.
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Telephone | 718-773-2011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 191343
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License Number State | NY
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