MEDICARE: ENRICHING LIVES THROUGH MEDICAL PHYSICIANS P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207QS1201X	Sleep Medicine (Family Medicine) Physician
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1326776170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENRICHING LIVES THROUGH MEDICAL PHYSICIANS P.C.

Provider Business Mailing Address
First Line	:	92 GREENWAY DR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3366
Country	:	US
Telephone Number	:	347-559-0133
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 NEW YORK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5508
Country	:	US
Telephone Number	:	347-559-0133
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	DR. ABHISHEK PANDEY
Credential	:
Telephone Number	:	347-559-0133

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	08/10/2022

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