MEDICARE: HUGUENOT MEDICAL SERVICES P.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	207R00000X	Internal Medicine Physician		NY

General Provider Information

NPI Number	:	1639447725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUGUENOT MEDICAL SERVICES P.C.

Provider Business Mailing Address
First Line	:	4459 AMBOY RD
Second Line	:	2ND FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3846
Country	:	US
Telephone Number	:	718-948-6177
Fax Number	:	718-948-8189

Provider Business Practice Location Address
First Line	:	5405 HYLAN BLVD
Second Line	:	STUITE 1
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-5201
Country	:	US
Telephone Number	:	718-948-5475
Fax Number	:	718-948-5479

Authorized Official
Title or Position	:	OWNER/ MEDICAL DIRECTOR
Name	:	DR. AHMED A. ELSOURY
Credential	:	M.D.
Telephone Number	:	718-948-5475

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	12/05/2011

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