=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992057392
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR.AFSER TASNEEM MEDICINE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2012
-----------------------------------------------------
Last Update Date | 10/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16833 HILLSIDE AVE
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-291-5270
-----------------------------------------------------
Fax | 718-291-5271
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16833 HILLSIDE AVE
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-291-5270
-----------------------------------------------------
Fax | 718-291-5271
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. AFSER TASNEEM
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 718-291-5270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number | 234120
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------