MEDICARE: P.R. 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	207R00000X	Internal Medicine Physician	196325	NY

General Provider Information

NPI Number	:	1639590862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P.R. MEDICAL PC

Provider Business Mailing Address
First Line	:	7909B NORTHERN BLVD
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1223
Country	:	US
Telephone Number	:	718-507-1438
Fax Number	:	718-507-1530

Provider Business Practice Location Address
First Line	:	7909B NORTHERN BLVD
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1223
Country	:	US
Telephone Number	:	718-507-1438
Fax Number	:	718-507-1530

Authorized Official
Title or Position	:	MD
Name	:	PERVAIZ IQBAL QURESHI
Credential	:
Telephone Number	:	718-507-1438

Provider Enumeration Date	:	12/13/2013
Last Update Date	:	12/13/2013

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Directions to “P.R. MEDICAL PC ” Practice Location

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