=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992131718
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARTHRITIS & OSTEOPOROSIS CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2013
-----------------------------------------------------
Last Update Date | 12/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21302 HILLSIDE AVE
-----------------------------------------------------
City | QUEENS VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11427-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-494-7538
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41 CHENANGO DR
-----------------------------------------------------
City | JERICHO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11753-1503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-494-7538
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SABIHA SHAHNAZ BANDAGI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 917-494-7538
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 227293
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------