MEDICARE: TAHREEM JAVED PA-C

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	363AM0700X	Medical Physician Assistant	020655	NY

General Provider Information

NPI Number	:	1376084830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAHREEM JAVED PA-C

Provider Business Mailing Address
First Line	:	29 NEWKIRK PLZ
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-6525
Country	:	US
Telephone Number	:	718-434-7545
Fax Number	:	718-434-7564

Provider Business Practice Location Address
First Line	:	29 NEWKIRK PLZ
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-6525
Country	:	US
Telephone Number	:	718-434-7545
Fax Number	:	718-434-7564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2017
Last Update Date	:	03/16/2017

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