MEDICARE: MB-SC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	247070	NY

General Provider Information

NPI Number	:	1023540606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MB-SC INC

Provider Business Mailing Address
First Line	:	146 AUTUMN CHASE DR
Second Line	:
City	:	HOPEWELL JCT
State	:	NY
Zip	:	12533-6574
Country	:	US
Telephone Number	:	631-627-9987
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 AUTUMN CHASE DR
Second Line	:
City	:	HOPEWELL JCT
State	:	NY
Zip	:	12533-6574
Country	:	US
Telephone Number	:	631-627-9987
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MUHAMMAD OMER BASHIR
Credential	:	M.D.
Telephone Number	:	631-627-9987

Provider Enumeration Date	:	04/01/2017
Last Update Date	:	04/01/2017

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