MEDICARE: HOLLIS MEDICAL PC

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	207Q00000X	Family Medicine Physician	243430	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	:	1356760052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLIS MEDICAL PC

Provider Business Mailing Address
First Line	:	8786 188TH ST
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-1131
Country	:	US
Telephone Number	:	718-480-6882
Fax Number	:	718-217-7653

Provider Business Practice Location Address
First Line	:	8786 188TH ST
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-1131
Country	:	US
Telephone Number	:	718-480-6882
Fax Number	:	718-217-7653

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	DR. MD MAHBUBUL ISLAM
Credential	:	MD
Telephone Number	:	718-480-6882

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	04/09/2014

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Directions to “HOLLIS MEDICAL PC ” Practice Location

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