MEDICARE: JAMIL ODEH PA

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	5234707	NY

General Provider Information

NPI Number	:	1679628424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIL ODEH PA

Provider Business Mailing Address
First Line	:	101 BROOKLYN AVE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2855
Country	:	US
Telephone Number	:	516-552-8658
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 E 68TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-4870
Country	:	US
Telephone Number	:	212-746-4935
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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Directions to “ JAMIL ODEH PA” Practice Location

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