MEDICARE: NEW YORK DIABETES AND ENDOCRINOLOGY PLLC

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	253659	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	:	1679003222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK DIABETES AND ENDOCRINOLOGY PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3609
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-8609
Country	:	US
Telephone Number	:	917-502-0617
Fax Number	:

Provider Business Practice Location Address
First Line	:	20801 HILLSIDE AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1711
Country	:	US
Telephone Number	:	917-502-0617
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	SAJID KHAN
Credential	:
Telephone Number	:	917-502-0617

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	06/15/2017

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