MEDICARE: HOLLIS MEDICAL OFFICE

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	207R00000X	Internal Medicine Physician	182925	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326532698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLIS MEDICAL OFFICE

Provider Business Mailing Address
First Line	:	19550 JAMAICA AVE
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-2664
Country	:	US
Telephone Number	:	718-776-9899
Fax Number	:	718-776-5005

Provider Business Practice Location Address
First Line	:	19550 JAMAICA AVE
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-2664
Country	:	US
Telephone Number	:	718-776-9899
Fax Number	:	718-776-5005

Authorized Official
Title or Position	:	INTERNAL MEDICINE
Name	:	DR. SYLVESTER A OZOUDE
Credential	:	MD
Telephone Number	:	718-776-9899

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	06/19/2018

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Directions to “HOLLIS MEDICAL OFFICE ” Practice Location

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